Healthcare Provider Details

I. General information

NPI: 1205619442
Provider Name (Legal Business Name): JARED WILLIAM MALOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JARED MALOTT PHARMD, RPH

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MIRANOVA PL STE 500
COLUMBUS OH
43215-7052
US

IV. Provider business mailing address

2 MIRANOVA PL STE 500
COLUMBUS OH
43215-7052
US

V. Phone/Fax

Practice location:
  • Phone: 614-321-9743
  • Fax: 614-647-0070
Mailing address:
  • Phone: 614-321-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031266A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03442402
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: