=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891839585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY HEALTH CONNECTION PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 05/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1581 DODD DR MCCAMPBELL HALL, ROOM 216
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43210-1257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-685-6473
-----------------------------------------------------
Fax | 614-688-0720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1581 DODD DR MCCAMPBELL HALL, ROOM 216
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43210-1257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-685-6473
-----------------------------------------------------
Fax | 614-688-0720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DR. CHRISTOPHER GEORGE GREEN
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 614-685-6473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | 02-1393900
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------