Provider Demographics
NPI:1861068405
Name:OHIO STATE UNIVERSITY OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:OHIO STATE UNIVERSITY OUTPATIENT PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:SCD, FACHE
Authorized Official - Phone:614-293-9806
Mailing Address - Street 1:600 ACKERMAN RD STE E1014
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-4500
Mailing Address - Country:US
Mailing Address - Phone:614-685-4188
Mailing Address - Fax:614-293-7822
Practice Address - Street 1:6100 N HAMILTON RD RM 1370
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2062
Practice Address - Country:US
Practice Address - Phone:614-366-7551
Practice Address - Fax:614-366-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy