Healthcare Provider Details

I. General information

NPI: 1992217657
Provider Name (Legal Business Name): CARLO LEGASTO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE RM C150
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

460 W 10TH AVE RM C150
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-1459
  • Fax:
Mailing address:
  • Phone: 614-293-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number03136122
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: