Provider Demographics
NPI:1326176850
Name:KENT STATE UNIVERSITY HEALTH CENTER
Entity Type:Organization
Organization Name:KENT STATE UNIVERSITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DAMICONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-672-8254
Mailing Address - Street 1:1500 EASTWAY DR, DEWEESE HEALTH CENTER
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-0001
Mailing Address - Country:US
Mailing Address - Phone:330-372-8254
Mailing Address - Fax:330-672-3711
Practice Address - Street 1:1500 EASTWAY DR, DEWEESE HEALTH CENTER
Practice Address - Street 2:KENT STATE UNIVERSITY HEALTH SERVICES PHARMACY
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-0001
Practice Address - Country:US
Practice Address - Phone:330-372-8254
Practice Address - Fax:330-672-3711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENT STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020259100332000000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3632444OtherNCPDP
OH3632444OtherNCPDP