Provider Demographics
NPI:1942246863
Name:WORTHINGTON INDUSTRIES MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WORTHINGTON INDUSTRIES MEDICAL CENTER, INC.
Other - Org Name:WORTHINGTON INDUSTRIES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-840-3537
Mailing Address - Street 1:1250 DEARBORN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4767
Mailing Address - Country:US
Mailing Address - Phone:614-840-3571
Mailing Address - Fax:866-690-8967
Practice Address - Street 1:1250 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4767
Practice Address - Country:US
Practice Address - Phone:614-840-3571
Practice Address - Fax:866-690-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-014393333600000X
KYOH2993336C0002X
MDP025003336C0002X
IN64000225A3336C0002X
WI254-0433336C0002X
TN49733336C0002X
NC111683336C0002X
KS22-029603336C0002X
OH02221167503336C0002X
AL1107323336C0002X
FLPH174733336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073686OtherPK