Provider Demographics
NPI:1124564786
Name:STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING
Entity Type:Organization
Organization Name:STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING
Other - Org Name:HEARTLAND PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROSALAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GATEWOOD-TYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-644-9142
Mailing Address - Street 1:30 EAST BROAD ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3413
Mailing Address - Country:US
Mailing Address - Phone:614-466-0111
Mailing Address - Fax:
Practice Address - Street 1:3000 ERIE ST S
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7976
Practice Address - Country:US
Practice Address - Phone:614-466-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy