36D0969074 CLIA NUMBER - OSU PRIMARY CARE OUTPATIENT CARE EAST

Laboratory Demographics

CLIA Number: 36D0969074

Facility Name: OSU PRIMARY CARE OUTPATIENT CARE EAST

Facility Address:
543 TAYLOR AVENUE, 2ND FLOOR
COLUMBUS, OH
ZIP 43203
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Facility Phone Number: 614 293-4494

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124683826

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	36D0969074
LAB Type	Physician Office
Facility Name	OSU PRIMARY CARE OUTPATIENT CARE EAST
Street	543 TAYLOR AVENUE, 2ND FLOOR
City	COLUMBUS
State	OH
ZIP	43203
Phone	614 293-4494
CertificateType	4
CertificateEffectiveDate	1/4/2024
CertificateExpirationDate	1/3/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024