Provider Demographics
NPI:1457435190
Name:CITY OF CINCINNATI
Entity Type:Organization
Organization Name:CITY OF CINCINNATI
Other - Org Name:BRAXTON CANN MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-352-3801
Mailing Address - Street 1:5818 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1708
Mailing Address - Country:US
Mailing Address - Phone:513-263-8760
Mailing Address - Fax:513-263-8787
Practice Address - Street 1:5818 MADISON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1708
Practice Address - Country:US
Practice Address - Phone:513-263-8760
Practice Address - Fax:513-263-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0202531003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074381OtherPK
OH0274966Medicaid
2074381OtherPK