Healthcare Provider Details

I. General information

NPI: 1447271861
Provider Name (Legal Business Name): JOHN D WURTZBACHER PHARM.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 FAR HILLS AVE
DAYTON OH
45419-1502
US

IV. Provider business mailing address

2419 FAR HILLS AVE
DAYTON OH
45419-1502
US

V. Phone/Fax

Practice location:
  • Phone: 937-654-3784
  • Fax: 937-293-8539
Mailing address:
  • Phone: 937-654-3784
  • Fax: 937-293-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-3-19939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: