Healthcare Provider Details

I. General information

NPI: 1518392414
Provider Name (Legal Business Name): HEALTH PARTNERS OF WESTERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N MAIN ST
NEW CARLISLE OH
45344-1835
US

IV. Provider business mailing address

106 N MAIN ST
NEW CARLISLE OH
45344-1835
US

V. Phone/Fax

Practice location:
  • Phone: 937-845-5987
  • Fax: 937-679-5260
Mailing address:
  • Phone: 937-845-5987
  • Fax: 937-679-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number022225700
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CLARK
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 419-221-3072