1568686087 NPI number — GREATER DAYTON CANCER CENTER PHARMACY

Table of content: (NPI 1568686087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568686087 NPI number — GREATER DAYTON CANCER CENTER PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER DAYTON CANCER CENTER PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAYTON ONCOLOGY AND HEMATOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568686087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3120 GOVERNORS PLACE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45409-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 GOVERNORS PLACE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-1328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-528-0334
Provider Business Practice Location Address Fax Number:
937-528-0472
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RHONE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
937-528-0334

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  021363050 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2422266 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0999960 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3671484 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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