Provider Demographics
NPI:1154517878
Name:OHIO VETERANS HOME PHARMACY-GEORGETOWN
Entity type:Organization
Organization Name:OHIO VETERANS HOME PHARMACY-GEORGETOWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:419-625-2454
Mailing Address - Street 1:7110 BACHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9456
Mailing Address - Country:US
Mailing Address - Phone:800-284-8741
Mailing Address - Fax:937-446-2600
Practice Address - Street 1:7110 BACHMAN RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-9456
Practice Address - Country:US
Practice Address - Phone:800-284-8741
Practice Address - Fax:937-446-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
OH0214167503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081057OtherPK