Healthcare Provider Details

I. General information

NPI: 1104514843
Provider Name (Legal Business Name): PAIGE LAVENDER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E MAIN ST
COLUMBUS OH
43215-5222
US

IV. Provider business mailing address

255 E MAIN ST
COLUMBUS OH
43215-5222
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-1100
  • Fax:
Mailing address:
  • Phone: 845-444-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03441135
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: