MEDICARE: COLUMBUS PRESCRIPTION WEST LLC

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	3336C0003X	Community/Retail Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3672931	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	3672931	OTHER	OTHER ID NUMBER

General Provider Information

NPI Number	:	1679576466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS PRESCRIPTION WEST LLC

Provider Business Mailing Address
First Line	:	2849 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2849 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2643
Country	:	US
Telephone Number	:	614-351-0062
Fax Number	:	614-351-0358

Authorized Official
Title or Position	:	CHIEF PHARMACIST
Name	:	JARROD GROSSMAN
Credential	:	RPL PHARMD
Telephone Number	:	614-351-0062

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/07/2008

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Directions to “COLUMBUS PRESCRIPTION WEST LLC ” Practice Location

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