Provider Demographics
NPI:1588769657
Name:NORWOOD, ELOISE A (RPH)
Entity type:Individual
Prefix:MS
First Name:ELOISE
Middle Name:A
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 COLLINGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1147
Mailing Address - Country:US
Mailing Address - Phone:419-255-5945
Mailing Address - Fax:
Practice Address - Street 1:1910 COLLINGWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5011
Practice Address - Country:US
Practice Address - Phone:419-244-1809
Practice Address - Fax:419-244-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-14972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
34-1493202OtherTAX ID #
OH0723480Medicaid