Healthcare Provider Details

I. General information

NPI: 1326176850
Provider Name (Legal Business Name): KENT STATE UNIVERSITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EASTWAY DR, DEWEESE HEALTH CENTER KENT STATE UNIVERSITY HEALTH SERVICES PHARMACY
KENT OH
44240-0001
US

IV. Provider business mailing address

1500 EASTWAY DR, DEWEESE HEALTH CENTER
KENT OH
44242-0001
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-8254
  • Fax: 330-672-3711
Mailing address:
  • Phone: 330-372-8254
  • Fax: 330-672-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number020259100
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020259100
License Number StateOH

VIII. Authorized Official

Name: MRS. LAURA JANE DAMICONE
Title or Position: CHIEF PHARMACIST
Credential: R.PH.
Phone: 330-672-8254