Provider Demographics
NPI:1396168076
Name:EAST LIVERPOOL CITY HOSPITAL OUT-PATIENT PHARMACY
Entity type:Organization
Organization Name:EAST LIVERPOOL CITY HOSPITAL OUT-PATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL AFFAIRS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:330-386-2954
Mailing Address - Street 1:425 W FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2405
Mailing Address - Country:US
Mailing Address - Phone:330-386-2002
Mailing Address - Fax:330-386-2074
Practice Address - Street 1:425 W FIFTH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2405
Practice Address - Country:US
Practice Address - Phone:330-386-2002
Practice Address - Fax:330-386-2074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCLPH.020399350033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2413481Medicaid
OH2413481Medicaid