Provider Demographics
NPI:1922005453
Name:CALLICOAT, DEBORAH W (CPHT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:CALLICOAT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3104
Mailing Address - Country:US
Mailing Address - Phone:513-579-3356
Mailing Address - Fax:513-579-3400
Practice Address - Street 1:704 DANBURY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3104
Practice Address - Country:US
Practice Address - Phone:513-742-3888
Practice Address - Fax:860-262-9889
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300101041152117183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician