Healthcare Provider Details

I. General information

NPI: 1043041874
Provider Name (Legal Business Name): COMPDRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

IV. Provider business mailing address

547 E 11TH AVE
COLUMBUS OH
43211-2603
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-4506
  • Fax: 614-291-0118
Mailing address:
  • Phone: 614-224-4506
  • Fax: 614-291-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY DUSTIN METS
Title or Position: CEO
Credential:
Phone: 614-224-4506