Provider Demographics
NPI:1316000920
Name:CITY OF CINCINNATI
Entity Type:Organization
Organization Name:CITY OF CINCINNATI
Other - Org Name:MILLVALE AT HOPPLE HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-352-3801
Mailing Address - Street 1:2750 BEEKMAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-2049
Mailing Address - Country:US
Mailing Address - Phone:513-352-3195
Mailing Address - Fax:513-352-4379
Practice Address - Street 1:2750 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-2049
Practice Address - Country:US
Practice Address - Phone:513-352-3195
Practice Address - Fax:513-352-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHCLPH.020249800-033336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073789OtherPK
OH0277034Medicaid
OH0277034Medicaid