Healthcare Provider Details

I. General information

NPI: 1871998427
Provider Name (Legal Business Name): GREGORY SAMIJLENKO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE 110 DOAN HALL
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

4191 BOULDER DAM DR
GAHANNA OH
43230-6309
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8470
  • Fax:
Mailing address:
  • Phone: 614-439-6719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03127032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: