Provider Demographics
NPI:1841606191
Name:MGH AMBULATORY PHARMACY
Entity Type:Organization
Organization Name:MGH AMBULATORY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-533-5264
Mailing Address - Street 1:1000 MCKINLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6399
Mailing Address - Country:US
Mailing Address - Phone:740-383-8424
Mailing Address - Fax:
Practice Address - Street 1:1000 MCKINLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6399
Practice Address - Country:US
Practice Address - Phone:740-383-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION GENERAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRTP 033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy