Provider Demographics
NPI:1073884342
Name:UNIVERSITY OF TOLEDO MEDICAL CTR - 340B
Entity Type:Organization
Organization Name:UNIVERSITY OF TOLEDO MEDICAL CTR - 340B
Other - Org Name:UTCARE PHARMACY - 340 B
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-383-3757
Mailing Address - Street 1:3000 ARLINGTON AVE # MS 1220
Mailing Address - Street 2:MS 1220
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-3355
Mailing Address - Fax:419-383-3369
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:ROOM 1341, SUITE M
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-3355
Practice Address - Fax:419-383-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0226738003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060289Medicaid
2133383OtherPK