Healthcare Provider Details

I. General information

NPI: 1578914040
Provider Name (Legal Business Name): VIRTUS OHIO PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9352 LEBANON PIKE STE B
CENTERVILLE OH
45458-3843
US

IV. Provider business mailing address

947 W MONTANA ST APT 3E
CHICAGO IL
60614-2429
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-5751
  • Fax: 937-435-5759
Mailing address:
  • Phone: 312-391-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPSNH.022586600-
License Number StateOH

VIII. Authorized Official

Name: RUTUL SHAH
Title or Position: PRINCIPAL
Credential:
Phone: 312-391-6845