Healthcare Provider Details

I. General information

NPI: 1942164645
Provider Name (Legal Business Name): OHIO STATE UNIVERSITY OUTPATIENT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 KENNY RD # 2025
COLUMBUS OH
43210-3100
US

IV. Provider business mailing address

600 ACKERMAN RD STE E1014
COLUMBUS OH
43202-4500
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-4477
  • Fax: 614-685-2154
Mailing address:
  • Phone: 614-685-4188
  • Fax: 614-293-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TRISHA JORDAN
Title or Position: CHIEF PHARMACY OFFICER
Credential: PHARMD
Phone: 614-293-8470