Healthcare Provider Details

I. General information

NPI: 1154854180
Provider Name (Legal Business Name): JENNIFER HUGHES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WAYNE AVE
DAYTON OH
45420-1833
US

IV. Provider business mailing address

2611 WAYNE AVE
DAYTON OH
45420-1833
US

V. Phone/Fax

Practice location:
  • Phone: 937-640-3045
  • Fax: 937-640-3085
Mailing address:
  • Phone: 937-640-3045
  • Fax: 937-640-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number03224946
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03224496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: