Provider Demographics
NPI:1922054634
Name:MEDICAL UNIVERSITY OF OHIO AT TOLEDO
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY OF OHIO AT TOLEDO
Other - Org Name:HEALTH SCIENCE CAMPUS OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-383-6668
Mailing Address - Street 1:3000 ARLINGTON AVE # MS 1076
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-3706
Mailing Address - Fax:419-383-3208
Practice Address - Street 1:3000 ARLINGTON AVE # MS 1076
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3706
Practice Address - Fax:419-383-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0214534003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9111115Medicaid
OH9111115Medicaid