1154322170 NPI number — WALTER ANDREW HERBSTER RPH, MBA

Table of content: WALTER ANDREW HERBSTER RPH, MBA (NPI 1154322170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154322170 NPI number — WALTER ANDREW HERBSTER RPH, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERBSTER
Provider First Name:
WALTER
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH, MBA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1154322170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4659 FARCREST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45247-6914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-535-2568
Provider Business Mailing Address Fax Number:
513-385-1072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5403 N BEND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45247-7620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-662-1541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  03-2-16832 , 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)





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