Healthcare Provider Details

I. General information

NPI: 1073594917
Provider Name (Legal Business Name): FIFI WIDAJAT RPH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SOLDANO BLVD
COLUMBUS OH
43228-1458
US

IV. Provider business mailing address

1253 FAREHARM DR
NEW ALBANY OH
43054-9239
US

V. Phone/Fax

Practice location:
  • Phone: 614-274-8108
  • Fax: 614-274-3417
Mailing address:
  • Phone: 614-506-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-2-23466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: