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General NPI Number Information
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NPI Number | 1013146950
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Entity Type | Organization
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Legal Business Name | IMMUNIZATION CONSULTANTS OF CENTRAL OHIO, LLC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 801 W CHERRY ST SUITE 129
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City | SUNBURY
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State | OH
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Zip | 43074-8573
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Country | US
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Telephone | 614-214-0128
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Fax |
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Provider Business Mailing Address
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Address Line | 801 W CHERRY ST SUITE 129
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City | SUNBURY
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State | OH
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Zip | 43074-8573
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Country | US
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Telephone | 614-214-0128
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DANIEL S WILLIAMS
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Credential | PHARM.D.
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Telephone | 614-214-0128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 021988950-12
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 021988950
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License Number State | OH
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