Healthcare Provider Details

I. General information

NPI: 1174123780
Provider Name (Legal Business Name): ANGELA R JEFFRIES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2020
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 N STATE ROUTE 53
FREMONT OH
43420-8628
US

IV. Provider business mailing address

2052 N STATE ROUTE 53
FREMONT OH
43420-8628
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-8410
  • Fax: 419-334-3223
Mailing address:
  • Phone: 419-334-8410
  • Fax: 419-334-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03122411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: