Provider Demographics
NPI:1902993876
Name:WEST END HEALTH CENTER INC
Entity Type:Organization
Organization Name:WEST END HEALTH CENTER INC
Other - Org Name:WEST END HEALTH CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-621-2726
Mailing Address - Street 1:1413 LINN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-2605
Mailing Address - Country:US
Mailing Address - Phone:513-621-2726
Mailing Address - Fax:513-621-1913
Practice Address - Street 1:1413 LINN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-2605
Practice Address - Country:US
Practice Address - Phone:513-621-2726
Practice Address - Fax:513-621-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0202616503336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0723060Medicaid
3634260OtherNCPDP PROVIDER IDENTIFICATION NUMBER
OH0723060Medicaid