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General NPI Number Information
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NPI Number | 1962542373
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Entity Type | Organization
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Legal Business Name | DEER PARK PHARMACY
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 4075 E GALBRAITH RD
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City | CINCINNATI
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State | OH
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Zip | 45236-2323
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Country | US
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Telephone | 513-791-7958
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Fax | 513-791-7541
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Provider Business Mailing Address
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Address Line | 4075 E GALBRAITH RD
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City | CINCINNATI
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State | OH
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Zip | 45236-2323
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Country | US
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Telephone | 513-791-7958
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Fax | 513-791-7541
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN D RATHMAN
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Credential | RPH
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Telephone | 513-791-7958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 020180400
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License Number State | OH
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