Healthcare Provider Details

I. General information

NPI: 1679576466
Provider Name (Legal Business Name): COLUMBUS PRESCRIPTION WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2849 W BROAD ST
COLUMBUS OH
43204-2643
US

IV. Provider business mailing address

2849 W BROAD ST
COLUMBUS OH
43204-2643
US

V. Phone/Fax

Practice location:
  • Phone: 614-351-0062
  • Fax: 614-351-0358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: JARROD GROSSMAN
Title or Position: CHIEF PHARMACIST
Credential: RPL PHARMD
Phone: 614-351-0062