Healthcare Provider Details

I. General information

NPI: 1760495089
Provider Name (Legal Business Name): SOUTHEAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N HIGH ST
COLUMBUS OH
43215-3018
US

IV. Provider business mailing address

131 N HIGH ST
COLUMBUS OH
43215-3018
US

V. Phone/Fax

Practice location:
  • Phone: 614-228-4476
  • Fax: 614-228-4479
Mailing address:
  • Phone: 614-228-4476
  • Fax: 614-228-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number021280650
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOAN WISSINGER
Title or Position: DIR OF PHRMCY
Credential: RPH
Phone: 614-228-4476