Healthcare Provider Details

I. General information

NPI: 1730748708
Provider Name (Legal Business Name): HEALTH PARTNERS OF WESTERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 W SENECA AVE
TIFFIN OH
44883-2652
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 567-938-0300
  • Fax: 419-481-8743
Mailing address:
  • Phone: 419-221-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DIANE RUSSELL
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 419-221-3072