Organization
GOOD SAMARITAN OUTPATIENT PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD KAES RPH (PHARMACY MANAGER)
(513) 872-3550
Entity
Organization
Contact information
Practice address
375 DIXMYTH AVE, CINCINNATI, OH 45220
(513) 872-1559
(513) 475-5878
Mailing address
375 DIXMYTH AVE, CINCINNATI, OH 45220
(513) 872-1559
(513) 475-5878
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
020030650
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020030650
TERMINAL DISTRIBUTER
OH
05
—
2312867
—
OH
01
—
3661851
NCPDP
OH
Enumeration date
10/06/2006
Last updated
10/08/2010
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