MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 2357
Change Report (if Any):

Short Name: DRUG/POISON INF

Long Name 1: DRUG AND POISON INFORMATION
Long Name 2: CENTER

Address 1: 3333 BURNET AVENUE VP 3
Address 2:

City: CINCINNATI
Zip Code: 45229
County: HAMI

Contact: TODD CARSON
Title:
Phone: 5136365063
FAX: 5136365070

Vendor: 2357

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012