Provider Demographics
NPI:1801573134
Name:ALTEV COMMUNITY PHARMACY LLC
Entity type:Organization
Organization Name:ALTEV COMMUNITY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYANJOKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:419-344-4392
Mailing Address - Street 1:3559 READING RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2688
Mailing Address - Country:US
Mailing Address - Phone:513-776-4580
Mailing Address - Fax:513-776-4590
Practice Address - Street 1:3559 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2666
Practice Address - Country:US
Practice Address - Phone:937-469-8235
Practice Address - Fax:513-672-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0024062Medicaid