Provider Demographics
NPI:1235379819
Name:HEALTHSOURCE OF OHIO INC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF OHIO INC
Other - Org Name:HEALTHSOURCE OF OHIO MT ORAB PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPS
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTUNNA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA
Authorized Official - Phone:513-732-5084
Mailing Address - Street 1:150 HEALTH PARTNERS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MT. ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154
Mailing Address - Country:US
Mailing Address - Phone:937-444-2514
Mailing Address - Fax:
Practice Address - Street 1:150 HEALTH PARTNERS CIRCLE
Practice Address - Street 2:
Practice Address - City:MT. ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154
Practice Address - Country:US
Practice Address - Phone:937-444-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy