Healthcare Provider Details

I. General information

NPI: 1174110217
Provider Name (Legal Business Name): AMBER FAUST CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 IRWIN SIMPSON RD
MASON OH
45040-9479
US

IV. Provider business mailing address

2784 LEOTA LN
CINCINNATI OH
45251-4538
US

V. Phone/Fax

Practice location:
  • Phone: 513-535-9334
  • Fax:
Mailing address:
  • Phone: 513-535-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30060184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: