Provider Demographics
NPI:1942742812
Name:MEDICAL UNIVERSITY OF OHIO AT TOLEDO
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY OF OHIO AT TOLEDO
Other - Org Name:UT ACCESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-383-5763
Mailing Address - Street 1:3000 ARLINGTON AVE
Mailing Address - Street 2:MAIL STOP 1225
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-5763
Mailing Address - Fax:419-383-2011
Practice Address - Street 1:3333 GLENDALE AVE # MS 1208
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2426
Practice Address - Country:US
Practice Address - Phone:419-383-5763
Practice Address - Fax:419-383-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
OH022668900-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166165OtherPK
OH0201088Medicaid