MEDICARE: JIMMY GUO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03237449	OH

General Provider Information

NPI Number	:	1194327957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY GUO PHARMD

Provider Business Mailing Address
First Line	:	3815 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3710
Country	:	US
Telephone Number	:	216-860-0023
Fax Number	:	216-860-0687

Provider Business Practice Location Address
First Line	:	3815 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-3710
Country	:	US
Telephone Number	:	216-860-0023
Fax Number	:	216-860-0687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	09/29/2021

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