Healthcare Provider Details

I. General information

NPI: 1962106922
Provider Name (Legal Business Name): JENNIFER M BARTHOLOMEW CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 TUSCARAWAS ST W
CANTON OH
44708-5619
US

IV. Provider business mailing address

3720 TUSCARAWAS ST W
CANTON OH
44708-5619
US

V. Phone/Fax

Practice location:
  • Phone: 440-258-4116
  • Fax:
Mailing address:
  • Phone: 440-258-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30118163
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: