Provider Demographics
NPI:1750436432
Name:FOSTORIA HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:FOSTORIA HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COEHRS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:567-585-3041
Mailing Address - Street 1:501 VAN BUREN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830
Mailing Address - Country:US
Mailing Address - Phone:419-435-6560
Mailing Address - Fax:419-435-6562
Practice Address - Street 1:501 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1534
Practice Address - Country:US
Practice Address - Phone:419-435-6560
Practice Address - Fax:419-435-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0216631503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080623OtherPK
OH2720210Medicaid
3675545OtherNCPDP