Provider Demographics
NPI:1265436661
Name:HILLCREST ATRIUM PHARMACY, INC
Entity type:Organization
Organization Name:HILLCREST ATRIUM PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:440-605-1611
Mailing Address - Street 1:6770 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-605-1611
Mailing Address - Fax:440-605-1622
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-605-1611
Practice Address - Fax:440-605-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02889300333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205281Medicaid
OH3661938OtherNCPOP NUMBER
OH0205281Medicaid
OH0205281Medicaid
OH=========00OtherWORKERS COMP