Provider Demographics
NPI:1518392414
Name:HEALTH PARTNERS OF WESTERN OHIO
Entity Type:Organization
Organization Name:HEALTH PARTNERS OF WESTERN OHIO
Other - Org Name:NEW CARLISLE COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-3072
Mailing Address - Street 1:106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-1835
Mailing Address - Country:US
Mailing Address - Phone:937-845-5987
Mailing Address - Fax:937-679-5260
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1835
Practice Address - Country:US
Practice Address - Phone:937-845-5987
Practice Address - Fax:937-679-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022225700333600000X
3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092874Medicaid
2141902OtherPK