Healthcare Provider Details

I. General information

NPI: 1104840420
Provider Name (Legal Business Name): JARROD WARREN GROSSMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 W BROAD ST PHARMACY
COLUMBUS OH
43204-2643
US

IV. Provider business mailing address

1583 PRESIDENTIAL DR APT A4
COLUMBUS OH
43212-1268
US

V. Phone/Fax

Practice location:
  • Phone: 614-351-0062
  • Fax: 614-351-0358
Mailing address:
  • Phone: 614-506-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-27183
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: