Healthcare Provider Details

I. General information

NPI: 1154517878
Provider Name (Legal Business Name): OHIO VETERANS HOME PHARMACY-GEORGETOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 BACHMAN RD
SARDINIA OH
45171-9456
US

IV. Provider business mailing address

7110 BACHMAN RD
SARDINIA OH
45171-9456
US

V. Phone/Fax

Practice location:
  • Phone: 800-284-8741
  • Fax: 937-446-2600
Mailing address:
  • Phone: 800-284-8741
  • Fax: 937-446-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number021416750
License Number StateOH

VIII. Authorized Official

Name: RANDALL HARRIS
Title or Position: PHARMACY OPERATIONS MANAGER
Credential: RPH
Phone: 419-625-2454