Healthcare Provider Details

I. General information

NPI: 1295411056
Provider Name (Legal Business Name): ZACHARY STEPHEN JAGODITZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 HARRISON AVE
CINCINNATI OH
45248-1606
US

IV. Provider business mailing address

7219 VISTA VIEW CIR
HARRISON OH
45030-7523
US

V. Phone/Fax

Practice location:
  • Phone: 513-574-5044
  • Fax:
Mailing address:
  • Phone: 513-213-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443167
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: