Provider Demographics
NPI:1770504748
Name:SISTERS OF NOTRE DAME OF TOLEDO
Entity Type:Organization
Organization Name:SISTERS OF NOTRE DAME OF TOLEDO
Other - Org Name:SISTERS OF NOTRE DAME PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-724-1365
Mailing Address - Street 1:3837 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3837 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4402
Practice Address - Country:US
Practice Address - Phone:419-724-1365
Practice Address - Fax:419-473-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3634640OtherOTHER ID NUMBER-COMMERCIAL NUMBER