Basic Information
| Provider Information | |||||||||
| NPI: | 1013210244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY HEALTH - ANDERSON HOSPITAL LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARNESS HEALTH PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 639922 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452639922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136244669 | ||||||||
| FaxNumber: | 5136244820 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 STATE ROAD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136244669 | ||||||||
| FaxNumber: | 5136244820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RALSTON | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4199965119 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | 021992150 | OH | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.