Healthcare Provider Details

I. General information

NPI: 1639450851
Provider Name (Legal Business Name): JENNIFER CLIFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LONDON RD
DELAWARE OH
43015-2613
US

IV. Provider business mailing address

8280 NEILSTON CROSSING DR
WESTERVILLE OH
43081-8716
US

V. Phone/Fax

Practice location:
  • Phone: 740-368-9380
  • Fax:
Mailing address:
  • Phone: 216-970-7542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03328835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: