Provider Demographics
NPI:1639560139
Name:INFINITY PHARMACY, LLC
Entity Type:Organization
Organization Name:INFINITY PHARMACY, LLC
Other - Org Name:INFINITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:AFFUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-591-3070
Mailing Address - Street 1:2773 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4408
Mailing Address - Country:US
Mailing Address - Phone:614-591-3070
Mailing Address - Fax:614-591-3071
Practice Address - Street 1:2773 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4408
Practice Address - Country:US
Practice Address - Phone:614-591-3070
Practice Address - Fax:614-591-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139863Medicaid