Provider Demographics
NPI:1942385661
Name:ELMWOOD PLACE PHARMACY INC.
Entity Type:Organization
Organization Name:ELMWOOD PLACE PHARMACY INC.
Other - Org Name:SHARONVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:THEURING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-242-5700
Mailing Address - Street 1:5275 WINNESTE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45232-1130
Mailing Address - Country:US
Mailing Address - Phone:513-242-5700
Mailing Address - Fax:513-482-5461
Practice Address - Street 1:5275 WINNESTE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1130
Practice Address - Country:US
Practice Address - Phone:513-242-5700
Practice Address - Fax:513-482-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0610128Medicaid
OH0610128Medicaid