MEDICARE: OHIO STATE UNIVERSITY OUTPATIENT PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy	03331027-3	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083038368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO STATE UNIVERSITY OUTPATIENT PHARMACY

Provider Business Mailing Address
First Line	:	600 ACKERMAN RD STE E1014
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-4500
Country	:	US
Telephone Number	:	614-685-1672
Fax Number	:	614-293-7822

Provider Business Practice Location Address
First Line	:	600 ACKERMAN RD
Second Line	:	SUITE E1014
City	:	COLUMBUS
State	:	OH
Zip	:	43202-4500
Country	:	US
Telephone Number	:	614-293-5155
Fax Number	:

Authorized Official
Title or Position	:	CHIEF PHARMACY OFFICER
Name	:	DR. TRISHA JORDAN
Credential	:	PHARMD
Telephone Number	:	614-293-8470

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/02/2026

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