Healthcare Provider Details

I. General information

NPI: 1043767502
Provider Name (Legal Business Name): VIRTUS OHIO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OBETZ RD PHARMACY DEPARTMENT
COLUMBUS OH
43207-4036
US

IV. Provider business mailing address

9352 DAYTON LEBANON PIKE SUITE B
CENTERVILLE OH
45458-3843
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-5751
  • Fax:
Mailing address:
  • Phone: 937-435-5751
  • Fax: 937-435-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAYE WEXLER
Title or Position: PRESIDENT
Credential:
Phone: 937-435-5751