Healthcare Provider Details

I. General information

NPI: 1518170323
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 QUARRY LAKES DR
SANDUSKY OH
44870-8635
US

IV. Provider business mailing address

9500 EUCLID AVE JJ10
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-609-2845
  • Fax: 419-609-2869
Mailing address:
  • Phone: 419-609-2845
  • Fax: 419-609-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number022173000
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIM LONGVILLE
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 216-636-7416