=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992255293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL CENTER WEST PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2016
-----------------------------------------------------
Last Update Date | 10/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5212 W BROAD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-851-5811
-----------------------------------------------------
Fax | 614-851-5837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5212 W BROAD ST
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-851-5811
-----------------------------------------------------
Fax | 614-851-5837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARM.D
-----------------------------------------------------
Name | DOUGLAS BIRKHIMER
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 614-209-6710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------