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General NPI Number Information
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NPI Number | 1326176850
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Entity Type | Organization
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Legal Business Name | KENT STATE UNIVERSITY HEALTH CENTER
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1500 EASTWAY DR, DEWEESE HEALTH CENTER KENT STATE UNIVERSITY HEALTH SERVICES PHARMACY
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City | KENT
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State | OH
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Zip | 44240-0001
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Country | US
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Telephone | 330-372-8254
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Fax | 330-672-3711
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Provider Business Mailing Address
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Address Line | 1500 EASTWAY DR, DEWEESE HEALTH CENTER
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City | KENT
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State | OH
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Zip | 44242-0001
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Country | US
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Telephone | 330-372-8254
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Fax | 330-672-3711
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Authorized Official
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Title or Position | CHIEF PHARMACIST
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Name | MRS. LAURA JANE DAMICONE
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Credential | R.PH.
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Telephone | 330-672-8254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332000000X
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Taxonomy Name | Military/U.S. Coast Guard Pharmacy
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License Number | 020259100
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 020259100
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License Number State | OH
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