Healthcare Provider Details

I. General information

NPI: 1093337024
Provider Name (Legal Business Name): HEALTH PARTNERS OF WESTERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 WOODVILLE RD
TOLEDO OH
43605-2381
US

IV. Provider business mailing address

405 WOODVILLE RD
TOLEDO OH
43605-2381
US

V. Phone/Fax

Practice location:
  • Phone: 419-249-1820
  • Fax: 419-249-1819
Mailing address:
  • Phone: 419-249-1820
  • Fax: 419-249-1819

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