Healthcare Provider Details

I. General information

NPI: 1063180040
Provider Name (Legal Business Name): TERESA DIRKSEN PUTHOFF PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2178
  • Fax: 614-722-2189
Mailing address:
  • Phone: 614-722-2178
  • Fax: 614-722-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-3-16024
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number03-3-16024
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: