Provider Demographics
NPI:1346956661
Name:UH ST. JOHN RETAIL PHARMACY
Entity Type:Organization
Organization Name:UH ST. JOHN RETAIL PHARMACY
Other - Org Name:UH ST. JOHN RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-935-2753
Mailing Address - Street 1:29000 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5219
Mailing Address - Country:US
Mailing Address - Phone:440-827-5122
Mailing Address - Fax:216-201-7153
Practice Address - Street 1:29000 CENTER RIDGE RD STE 403
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5219
Practice Address - Country:US
Practice Address - Phone:440-827-5122
Practice Address - Fax:216-201-7153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UH MEDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-30
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy