Provider Demographics
NPI:1922779248
Name:BLOOD & CANCER CENTER INC
Entity Type:Organization
Organization Name:BLOOD & CANCER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-533-3040
Mailing Address - Street 1:3695A BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9009
Mailing Address - Country:US
Mailing Address - Phone:330-533-3040
Mailing Address - Fax:330-533-9459
Practice Address - Street 1:3695A BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9009
Practice Address - Country:US
Practice Address - Phone:330-533-3040
Practice Address - Fax:330-533-9459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLOOD & CANCER CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3682487OtherNCPDP
OH0703573Medicaid