=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548590789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALVIN JOHN HOMAN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2010
-----------------------------------------------------
Last Update Date | 01/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8264 W STATE ROUTE 41
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45318-1248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-473-3333
-----------------------------------------------------
Fax | 937-473-3000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 172 S GARFIELD ST
-----------------------------------------------------
City | MINSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45865-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-628-3198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03211249
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------