Provider Demographics
NPI:1336263029
Name:STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING
Entity Type:Organization
Organization Name:STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING
Other - Org Name:CENTRAL PHARMACY OUTPATIENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OHIOMHAS OPS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-752-0116
Mailing Address - Street 1:2150 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1257
Mailing Address - Country:US
Mailing Address - Phone:614-752-0150
Mailing Address - Fax:614-752-0151
Practice Address - Street 1:2150 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1257
Practice Address - Country:US
Practice Address - Phone:614-752-0150
Practice Address - Fax:614-752-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
OH0201718003336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143244OtherPK