Provider Demographics
NPI:1730215799
Name:UNIVERSITY OF CINCINNATI PHYSICIANS COMPANY LLC
Entity type:Organization
Organization Name:UNIVERSITY OF CINCINNATI PHYSICIANS COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEST
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD,BCPS,FASHP
Authorized Official - Phone:513-585-8005
Mailing Address - Street 1:2751 O VARISTY WAY
Mailing Address - Street 2:ROOM #335-A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45221-0010
Mailing Address - Country:US
Mailing Address - Phone:513-556-6091
Mailing Address - Fax:513-556-1523
Practice Address - Street 1:2751 O VARISTY WAY
Practice Address - Street 2:ROOM #335-A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45221-0010
Practice Address - Country:US
Practice Address - Phone:513-556-6091
Practice Address - Fax:513-556-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-10874003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3646481OtherNCPDP