MEDICARE: DEER PARK PHARMACY

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	3336C0003X	Community/Retail Pharmacy	020180400	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

General Provider Information

NPI Number	:	1962542373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER PARK PHARMACY

Provider Business Mailing Address
First Line	:	4075 E GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2323
Country	:	US
Telephone Number	:	513-791-7958
Fax Number	:	513-791-7541

Provider Business Practice Location Address
First Line	:	4075 E GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2323
Country	:	US
Telephone Number	:	513-791-7958
Fax Number	:	513-791-7541

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEVEN D RATHMAN
Credential	:	RPH
Telephone Number	:	513-791-7958

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	02/13/2008

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Directions to “DEER PARK PHARMACY ” Practice Location

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