Provider Demographics
NPI:1184833923
Name:ONCOLOGY HEMATOLOGY CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY CARE PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-751-2145
Mailing Address - Street 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:4350 MALSBARY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5665
Practice Address - Country:US
Practice Address - Phone:513-891-4800
Practice Address - Fax:513-792-5844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCOLOGY HEMATOLOGY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-21
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-19389003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2856262Medicaid