Healthcare Provider Details

I. General information

NPI: 1386089670
Provider Name (Legal Business Name): LAKEWOOD HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14519 DETROIT AVE
LAKEWOOD OH
44107-4316
US

IV. Provider business mailing address

14519 DETROIT AVE
LAKEWOOD OH
44107-4316
US

V. Phone/Fax

Practice location:
  • Phone: 216-529-7039
  • Fax: 216-529-7218
Mailing address:
  • Phone: 216-529-7039
  • Fax: 216-529-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number020032700
License Number StateOH

VIII. Authorized Official

Name: MICHAEL WASCOVICH
Title or Position: SR. DIRECTOR
Credential:
Phone: 216-445-2357