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General NPI Number Information
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NPI Number | 1376612119
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF OHIO INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 218 STERN RD
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City | SEAMAN
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State | OH
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Zip | 45679-9607
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Country | US
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Telephone | 937-386-0049
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Fax | 937-386-0230
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Provider Business Mailing Address
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Address Line | 424 WARDS CORNER RD STE 200
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City | LOVELAND
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State | OH
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Zip | 45140-6966
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Country | US
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Telephone | 513-707-4041
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Fax | 513-576-1020
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH W PRATHER II
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Credential | MD
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Telephone | 513-707-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 02-1220950
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License Number State | OH
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