Basic Information
| Provider Information | |||||||||
| NPI: | 1598290157 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NCH YELLOW PHARMACY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NCH YELLOW PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHILDREN'S DRIVE | ||||||||
| Address2: | NATIONWIDE CHILDREN'S PHARMACY | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147222181 | ||||||||
| FaxNumber: | 6147222189 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 BUTTERFLY GARDEN DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143557160 | ||||||||
| FaxNumber: | 6143557189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 04/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | KAPPELER | ||||||||
| AuthorizedOfficialFirstName: | KARL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER, AMBULATORY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6147222181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0002X | PMY.022732550-0 | OH | Y | Suppliers | Pharmacy | Clinic Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2168881 | 01 | PK | OTHER | 1473276 | 05 | OH | MEDICAID |