Healthcare Provider Details

I. General information

NPI: 1083610307
Provider Name (Legal Business Name): RUTH EILEEN EMPTAGE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 W MOUND ST
COLUMBUS OH
43223-1809
US

IV. Provider business mailing address

500 W 12TH AVE
COLUMBUS OH
43210-1214
US

V. Phone/Fax

Practice location:
  • Phone: 614-437-2894
  • Fax:
Mailing address:
  • Phone: 614-292-0093
  • Fax: 614-292-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-18885
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: