Healthcare Provider Details

I. General information

NPI: 1922673078
Provider Name (Legal Business Name): JENNIFER MARIE FUSAKIO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2316
US

IV. Provider business mailing address

234 GOODMAN ST
CINCINNATI OH
45219-2316
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8372
  • Fax:
Mailing address:
  • Phone: 513-584-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number03331118
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: