Healthcare Provider Details

I. General information

NPI: 1669493623
Provider Name (Legal Business Name): MEDICAL UNIVERSITY OF OHIO AT TOLEDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W BANCROFT ST # MS 513 VALERIE HOUSEHOLDER
TOLEDO OH
43606-3328
US

IV. Provider business mailing address

2801 W BANCROFT ST # MS 513 VALERIE HOUSEHOLDER
TOLEDO OH
43606-3328
US

V. Phone/Fax

Practice location:
  • Phone: 419-530-3471
  • Fax: 419-530-3473
Mailing address:
  • Phone: 419-530-3471
  • Fax: 419-530-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number020257500
License Number StateOH

VIII. Authorized Official

Name: DAVE MORLOCK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RPH
Phone: 419-530-3471