Provider Demographics
NPI:1629092168
Name:AKRON GEN MED CTR AMB CARE CTR PHCY
Entity Type:Organization
Organization Name:AKRON GEN MED CTR AMB CARE CTR PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-7732
Mailing Address - Street 1:1 AKRON GENERAL AVE.
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307
Mailing Address - Country:US
Mailing Address - Phone:330-344-7732
Mailing Address - Fax:330-996-2927
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:BLDG 301
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-7732
Practice Address - Fax:330-996-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-01579003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210793Medicaid