Provider Demographics
NPI:1740647031
Name:H.B. MAGRUDER MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:H.B. MAGRUDER MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESPONSIBLE PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-734-3131
Mailing Address - Street 1:615 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2001
Mailing Address - Country:US
Mailing Address - Phone:419-734-3131
Mailing Address - Fax:419-732-4078
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:419-732-4078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H.B. MAGRUDER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0225767503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy