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General NPI Number Information
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NPI Number | 1578914040
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Entity Type | Organization
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Legal Business Name | VIRTUS OHIO PHARMACY, LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 9352 LEBANON PIKE STE B
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City | CENTERVILLE
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State | OH
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Zip | 45458-3843
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Country | US
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Telephone | 937-435-5751
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Fax | 937-435-5759
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Provider Business Mailing Address
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Address Line | 947 W MONTANA ST APT 3E
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City | CHICAGO
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State | IL
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Zip | 60614-2429
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Country | US
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Telephone | 312-391-6845
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | RUTUL SHAH
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Credential |
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Telephone | 312-391-6845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PSNH.022586600-
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License Number State | OH
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