Healthcare Provider Details

I. General information

NPI: 1881530194
Provider Name (Legal Business Name): AXSOME ONMYSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E CAMPUS VIEW BLVD STE 210
COLUMBUS OH
43235-6621
US

IV. Provider business mailing address

14500 N NORTHSIGHT BLVD STE 307
SCOTTSDALE AZ
85260-3663
US

V. Phone/Fax

Practice location:
  • Phone: 855-977-0975
  • Fax: 888-975-0603
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: HALEY HANLE
Title or Position: COMPLIANCE
Credential:
Phone: 855-977-0975