Healthcare Provider Details

I. General information

NPI: 1639586498
Provider Name (Legal Business Name): UPTOWN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N STATE ST
WESTERVILLE OH
43081-2113
US

IV. Provider business mailing address

23 N. STATE ST.
WESTERVILLE OH
43081-2113
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-2392
  • Fax: 614-882-2399
Mailing address:
  • Phone: 614-882-2392
  • Fax: 614-882-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number03233874
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JARRETT LEWIS BAUDER
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 614-882-2392