Provider Demographics
NPI:1841916905
Name:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-543-4166
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-1000
Mailing Address - Fax:
Practice Address - Street 1:215 W BOWERY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:866-833-3784
Practice Address - Fax:330-543-6643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020616250OtherSTATE OF OHIO BOARD OF PHARMACY