Healthcare Provider Details

I. General information

NPI: 1538080403
Provider Name (Legal Business Name): OHIO INTAKE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 S 2ND ST STE 405
HAMILTON OH
45011-2846
US

IV. Provider business mailing address

3121 DIABLO AVE
HAYWARD CA
94545-2701
US

V. Phone/Fax

Practice location:
  • Phone: 800-874-5881
  • Fax:
Mailing address:
  • Phone: 855-910-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL GREENALL
Title or Position: MANAGER
Credential:
Phone: 855-910-8606