Healthcare Provider Details

I. General information

NPI: 1841961380
Provider Name (Legal Business Name): JOHN CHARLES KOEPKE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DRIVE PHARMACY DEPT
COLUMBUS OH
43205
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE PHARMACY DEPT
COLUMBUS OH
43205
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2192
  • Fax: 614-722-2488
Mailing address:
  • Phone: 614-722-2192
  • Fax: 614-722-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number03314394
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: