MEDICARE: CUYAHOGA COUNTY CORRECTIONS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist

General Provider Information

NPI Number	:	1033538129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUYAHOGA COUNTY CORRECTIONS CENTER

Provider Business Mailing Address
First Line	:	1215 W 3RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1532
Country	:	US
Telephone Number	:	216-443-7234
Fax Number	:	216-443-6003

Provider Business Practice Location Address
First Line	:	1215 W 3RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1532
Country	:	US
Telephone Number	:	216-443-7234
Fax Number	:	216-443-6003

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. IFTIKHAR HUSSAIN
Credential	:	RPH
Telephone Number	:	216-443-6208

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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