=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336712884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTORS PHARMACY DOWNTOWN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2021
-----------------------------------------------------
Last Update Date | 02/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 S GRANT AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-562-9101
-----------------------------------------------------
Fax | 614-706-4594
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 S GRANT AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-562-9101
-----------------------------------------------------
Fax | 614-706-4594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DR. GERALD JACKSON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 614-562-9101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------