MEDICARE: HILLCREST ATRIUM PHARMACY, INC

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	333600000X	Pharmacy	02889300	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3661938	OTHER	OH	NCPOP NUMBER

General Provider Information

NPI Number	:	1265436661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST ATRIUM PHARMACY, INC

Provider Business Mailing Address
First Line	:	6770 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2299
Country	:	US
Telephone Number	:	440-605-1611
Fax Number	:	440-605-1622

Provider Business Practice Location Address
First Line	:	6770 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-2299
Country	:	US
Telephone Number	:	440-605-1611
Fax Number	:	440-605-1622

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WARREN DAVID FRIEDMAN
Credential	:	RPH
Telephone Number	:	440-605-1611

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/21/2012

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