Healthcare Provider Details

I. General information

NPI: 1578846879
Provider Name (Legal Business Name): DR. JAMIE HRADESKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 W BROAD ST
COLUMBUS OH
43228-1612
US

IV. Provider business mailing address

5903 BROOMWOOD LOOP S
COLUMBUS OH
43230-8515
US

V. Phone/Fax

Practice location:
  • Phone: 614-851-1126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03329010
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: