Healthcare Provider Details

I. General information

NPI: 1912381237
Provider Name (Legal Business Name): JESSICA NICOLE HATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 S EDWIN C MOSES BLVD
DAYTON OH
45402-8472
US

IV. Provider business mailing address

230 N MAIN ST
DAYTON OH
45402-1263
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-0118
  • Fax: 937-558-0176
Mailing address:
  • Phone: 937-487-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03334757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: