Provider Demographics
NPI:1043798911
Name:GCGA PHYSICIANS INC.
Entity Type:Organization
Organization Name:GCGA PHYSICIANS INC.
Other - Org Name:OHIO GI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-751-6667
Mailing Address - Street 1:2925 VERNON PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-751-6667
Mailing Address - Fax:513-872-7625
Practice Address - Street 1:2925 VERNON PLACE
Practice Address - Street 2:SUITE 203
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-751-6667
Practice Address - Fax:513-872-7625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GCGA PHYSICIANS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-02
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02320000153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232000015OtherOHIO BOARD OF PHARMACY