Healthcare Provider Details

I. General information

NPI: 1669550174
Provider Name (Legal Business Name): WEST BROAD MED PHCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 W BROAD ST
COLUMBUS OH
43204-3333
US

IV. Provider business mailing address

2575 W BROAD ST
COLUMBUS OH
43204-3333
US

V. Phone/Fax

Practice location:
  • Phone: 614-279-7722
  • Fax: 614-279-7723
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: TRACY HAMMOND
Title or Position: THIRD PARTY ADMIN
Credential:
Phone: 614-481-4272