Healthcare Provider Details

I. General information

NPI: 1265436661
Provider Name (Legal Business Name): HILLCREST ATRIUM PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 MAYFIELD RD
MAYFIELD HTS OH
44124-2299
US

IV. Provider business mailing address

6770 MAYFIELD RD
MAYFIELD HTS OH
44124-2299
US

V. Phone/Fax

Practice location:
  • Phone: 440-605-1611
  • Fax: 440-605-1622
Mailing address:
  • Phone: 440-605-1611
  • Fax: 440-605-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number02889300
License Number StateOH

VIII. Authorized Official

Name: WARREN DAVID FRIEDMAN
Title or Position: PRESIDENT
Credential: RPH
Phone: 440-605-1611