MEDICARE: PHARMISERV CORP

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	020150350	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3634121	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710998356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMISERV CORP

Provider Business Mailing Address
First Line	:	5212 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1642
Country	:	US
Telephone Number	:	614-878-9665
Fax Number	:	614-878-4660

Provider Business Practice Location Address
First Line	:	5212 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1642
Country	:	US
Telephone Number	:	614-878-9665
Fax Number	:	614-878-4660

Authorized Official
Title or Position	:	MANAGER
Name	:	DEBRA STEUER
Credential	:	RPH
Telephone Number	:	614-878-9665

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	02/14/2011

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Directions to “PHARMISERV CORP ” Practice Location

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