Provider Demographics
NPI:1346402609
Name:MERCY HEALTH CINCINNATI LLC
Entity Type:Organization
Organization Name:MERCY HEALTH CINCINNATI LLC
Other - Org Name:HARNESS HEALTH PHARMACY- HOME DELIVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR PAYOR ADMINSTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:7160 INDUSTRIAL ROW DR STE 330
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1695
Mailing Address - Country:US
Mailing Address - Phone:513-557-7650
Mailing Address - Fax:513-557-7675
Practice Address - Street 1:7160 INDUSTRIAL ROW DR STE 330
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1695
Practice Address - Country:US
Practice Address - Phone:513-557-7650
Practice Address - Fax:513-557-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMOP.020030950-033336C0003X
3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2144478Medicaid
2077475OtherPK