Healthcare Provider Details

I. General information

NPI: 1144789850
Provider Name (Legal Business Name): JEFF DAVIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

1149 KINNETON
COLUMBUS OH
43228-9334
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-9199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03234106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: