Provider Demographics
NPI:1245394469
Name:UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC
Other - Org Name:UC - MEDICAL CENTER - HOXWORTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOBAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-584-8807
Mailing Address - Street 1:234 GOODMAN ST
Mailing Address - Street 2:ML 0739
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-8828
Mailing Address - Fax:513-584-2728
Practice Address - Street 1:3130 HIGHLAND AVE RM G200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2333
Practice Address - Country:US
Practice Address - Phone:513-584-8828
Practice Address - Fax:513-584-2728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-21
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0214503503336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141346Medicaid
OH4686880001Medicare NSC