Provider Demographics
NPI:1093813768
Name:ALLEN COUNTY HEALTH PARTNERS
Entity Type:Organization
Organization Name:ALLEN COUNTY HEALTH PARTNERS
Other - Org Name:ALLEN COUNTY HEALTH PARTNERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-222-1680
Mailing Address - Street 1:441 E 8TH ST
Mailing Address - Street 2:PHARMACY
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2482
Mailing Address - Country:US
Mailing Address - Phone:419-221-3723
Mailing Address - Fax:419-221-1726
Practice Address - Street 1:441 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2482
Practice Address - Country:US
Practice Address - Phone:419-221-3723
Practice Address - Fax:419-221-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021612850333600000X
3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2680460Medicaid
2080479OtherPK