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General NPI Number Information
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NPI Number | 1316341373
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Entity Type | Organization
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Legal Business Name | SOUTHERN OHIO MEDICAL CENTER
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-356-8060
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Fax | 740-356-8514
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Provider Business Mailing Address
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Address Line | 1805 27TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2640
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Country | US
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Telephone | 740-356-8113
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Fax | 740-356-8514
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | RORY PHILLIPS
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Credential |
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Telephone | 740-356-8113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 022457650
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License Number State | OH
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