Healthcare Provider Details

I. General information

NPI: 1902521990
Provider Name (Legal Business Name): ANDREA R REX CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GRACELAND BLVD
COLUMBUS OH
43214-7508
US

IV. Provider business mailing address

7587 CANTER RIDGE LN
WORTHINGTON OH
43085-4919
US

V. Phone/Fax

Practice location:
  • Phone: 614-981-0573
  • Fax:
Mailing address:
  • Phone: 614-981-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number09312712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: