Provider Demographics
NPI:1669111746
Name:OHIO STATE UNIVERSITY OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:OHIO STATE UNIVERSITY OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:SCD, FACHE
Authorized Official - Phone:614-293-9806
Mailing Address - Street 1:600 ACKERMAN RD
Mailing Address - Street 2:SUITE E1014
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202
Mailing Address - Country:US
Mailing Address - Phone:614-685-4188
Mailing Address - Fax:
Practice Address - Street 1:6700 UNIVERSITY BOULEVARD
Practice Address - Street 2:ROOM 1370A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016
Practice Address - Country:US
Practice Address - Phone:614-814-7001
Practice Address - Fax:614-814-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy