Provider Demographics
NPI:1578914040
Name:VIRTUS OHIO PHARMACY, LLC
Entity Type:Organization
Organization Name:VIRTUS OHIO PHARMACY, LLC
Other - Org Name:CENTERVILLE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:RUTUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-391-6845
Mailing Address - Street 1:947 W MONTANA ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2429
Mailing Address - Country:US
Mailing Address - Phone:312-391-6845
Mailing Address - Fax:
Practice Address - Street 1:9352 LEBANON PIKE STE B
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3843
Practice Address - Country:US
Practice Address - Phone:937-435-5751
Practice Address - Fax:937-435-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPSNH.022586600-3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160200OtherPK