Healthcare Provider Details

I. General information

NPI: 1891144986
Provider Name (Legal Business Name): VIRTUS OHIO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 ALEXANDERSVILLE RD
MIAMISBURG OH
45342-3658
US

IV. Provider business mailing address

436 ALEXANDERSVILLE RD
MIAMISBURG OH
45342-3658
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-5751
  • Fax: 937-435-5759
Mailing address:
  • Phone: 937-435-5751
  • Fax: 937-435-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPSNH.022586600-
License Number StateOH

VIII. Authorized Official

Name: RUTUL SHAH
Title or Position: CEO
Credential: PHARMD
Phone: 312-391-6845