Provider Demographics
NPI:1467781831
Name:CENTRAL OHIO COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:CENTRAL OHIO COMPOUNDING PHARMACY
Other - Org Name:CENTRAL OHIO COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-847-0109
Mailing Address - Street 1:5625 N HIGH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3964
Mailing Address - Country:US
Mailing Address - Phone:614-847-0109
Mailing Address - Fax:614-847-0960
Practice Address - Street 1:5625 N HIGH ST STE 1
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3964
Practice Address - Country:US
Practice Address - Phone:614-847-0109
Practice Address - Fax:614-847-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0210506503336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141079OtherPK