Healthcare Provider Details

I. General information

NPI: 1831753656
Provider Name (Legal Business Name): ALLISON JAYNE BAVERMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3802 ENCLAVE AVE APT 9
CINCINNATI OH
45241-2990
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-3100
  • Fax:
Mailing address:
  • Phone: 513-484-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03338140
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: