Provider Demographics
NPI:1093804783
Name:THE TOLEDO HOSPITAL
Entity Type:Organization
Organization Name:THE TOLEDO HOSPITAL
Other - Org Name:PROMEDICA SPECIALTY PHARMACY #2
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COEHRS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:567-585-3041
Mailing Address - Street 1:2150 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3834
Mailing Address - Country:US
Mailing Address - Phone:419-291-8530
Mailing Address - Fax:419-479-3293
Practice Address - Street 1:2109 HUGHES DR STE 840
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5113
Practice Address - Country:US
Practice Address - Phone:419-291-8530
Practice Address - Fax:419-479-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRTP.020811250-03333600000X
MI53010110623336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073692OtherPK
OH0105497Medicaid
2073692OtherPK