Provider Demographics
NPI:1821017336
Name:MIAMI UNIVERSITY STUDENT HEALTH SERVICE PHARMACY
Entity Type:Organization
Organization Name:MIAMI UNIVERSITY STUDENT HEALTH SERVICE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN RYAN
Authorized Official - Last Name:POPPENDECK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-529-3000
Mailing Address - Street 1:421 S CAMPUS AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2487
Mailing Address - Country:US
Mailing Address - Phone:513-529-3000
Mailing Address - Fax:513-529-1892
Practice Address - Street 1:421 S CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-2487
Practice Address - Country:US
Practice Address - Phone:513-529-3000
Practice Address - Fax:513-529-1892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI UNIVERSITY STUDENT HEALTH SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720056948Medicare UPIN