Provider Demographics
NPI:1477832822
Name:THE CENTERS FOR FAMILIES AND CHILDREN PHARMACY # 2
Entity Type:Organization
Organization Name:THE CENTERS FOR FAMILIES AND CHILDREN PHARMACY # 2
Other - Org Name:CENTER FOR FAMILIES AND CHILDREN PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-373-2846
Mailing Address - Street 1:3929 ROCKY RIVER DR STE P-101
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4153
Mailing Address - Country:US
Mailing Address - Phone:216-252-5800
Mailing Address - Fax:216-252-9055
Practice Address - Street 1:3929 ROCKY RIVER DR STE P-101
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4153
Practice Address - Country:US
Practice Address - Phone:216-252-5800
Practice Address - Fax:216-252-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
OH022135000-33336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053834Medicaid
2131637OtherPK