Provider Demographics
NPI:1487040697
Name:MOUNT CARMEL WEST OUTPATIENT PHARMACY
Entity Type:Organization
Organization Name:MOUNT CARMEL WEST OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-234-1224
Mailing Address - Street 1:793 W STATE ST
Mailing Address - Street 2:SUITE OPC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1551
Mailing Address - Country:US
Mailing Address - Phone:614-234-5087
Mailing Address - Fax:614-234-5535
Practice Address - Street 1:793 W STATE ST
Practice Address - Street 2:SUITE OPC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1551
Practice Address - Country:US
Practice Address - Phone:614-234-5087
Practice Address - Fax:614-234-5535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT CARMEL WEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022494100-03333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy