Healthcare Provider Details

I. General information

NPI: 1689458762
Provider Name (Legal Business Name): LICKING MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 WEST MAIN STREET SUITE 401
NEWARK OH
43055
US

IV. Provider business mailing address

1320 WEST MAIN STREET
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4544
  • Fax:
Mailing address:
  • Phone: 220-564-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA L WEBSTER
Title or Position: VP, FINANCIAL SERVICES
Credential:
Phone: 220-564-4518