Healthcare Provider Details

I. General information

NPI: 1932424272
Provider Name (Legal Business Name): PHILLIPS CLINIC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 EAST MAIN STREET SUITE 201
COLUMBUS OH
43205
US

IV. Provider business mailing address

881 EAST MAIN STREET SUITE 201
COLUMBUS OH
43205
US

V. Phone/Fax

Practice location:
  • Phone: 614-258-3787
  • Fax: 614-258-3789
Mailing address:
  • Phone: 614-258-3787
  • Fax: 614-258-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number022030750
License Number StateOH

VIII. Authorized Official

Name: CHRISTOPHER AKUNNE
Title or Position: RPH/MEMBER
Credential:
Phone: 614-253-2344