Healthcare Provider Details

I. General information

NPI: 1801575246
Provider Name (Legal Business Name): MARIANA PROFFITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 MIAMI AVE
MADEIRA OH
45243-2633
US

IV. Provider business mailing address

6950 MIAMI AVE
MADEIRA OH
45243-2633
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-1360
  • Fax:
Mailing address:
  • Phone: 513-271-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number023620
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03443205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: