MEDICARE: MICHAEL ROOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03224933	OH

General Provider Information

NPI Number	:	1609158005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ROOT

Provider Business Mailing Address
First Line	:	82 RICHARDS RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W 10TH AVE # 111
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:	614-293-3313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	09/13/2011

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Directions to “ MICHAEL ROOT ” Practice Location

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