Organization
HOLZER HOSPITAL FOUNDATION
Active
Other names
Holzer Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA BOOHER (DIRECTOR OF CREDENTIALING)
(740) 446-5551
Entity
Organization
Contact information
Practice address
448 JACKSON PIKE, GALLIPOLIS, OH 45631-1324
(740) 446-5000
Mailing address
448 JACKSON PIKE, GALLIPOLIS, OH 45631-1324
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232000280
LICENSE TO DISTRIBUTE DANGEROUS DRUGS
OH
Enumeration date
11/03/2021
Last updated
11/03/2021
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