MEDICARE: CARDINAL HEALTH 414, LLC

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	3336N0007X	Nuclear Pharmacy	60006375A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146742	OTHER		PK

General Provider Information

NPI Number	:	1508272691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL HEALTH 414, LLC

Provider Business Mailing Address
First Line	:	7000 CARDINAL PL
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-1091
Country	:	US
Telephone Number	:	614-757-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 AIRPORT N, SUITE D
Second Line	:
City	:	FT. WAYNE
State	:	IN
Zip	:	46825
Country	:	US
Telephone Number	:	260-489-1173
Fax Number	:

Authorized Official
Title or Position	:	VP OPERATIONS
Name	:	PAUL GOTTI
Credential	:
Telephone Number	:	614-757-5114

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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