Provider Demographics
NPI:1184030330
Name:CARDINAL HEALTH 414, LLC
Entity Type:Organization
Organization Name:CARDINAL HEALTH 414, LLC
Other - Org Name:CARDINAL HEALTH 414, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-757-5114
Mailing Address - Street 1:7000 CARDINAL PL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1091
Mailing Address - Country:US
Mailing Address - Phone:614-757-7570
Mailing Address - Fax:
Practice Address - Street 1:3305 LATHROP ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-4400
Practice Address - Country:US
Practice Address - Phone:574-233-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60006376A3336N0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146684OtherPK