=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437668183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO NORTHERN UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 W LINCOLN AVE
-----------------------------------------------------
City | ADA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-772-3784
-----------------------------------------------------
Fax | 419-772-3783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 S MAIN ST
-----------------------------------------------------
City | ADA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45810-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-772-3784
-----------------------------------------------------
Fax | 419-772-3783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF PHARMACY SERVICES
-----------------------------------------------------
Name | KATIE WESTGERDES
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 419-772-2659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 022816750
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------