Healthcare Provider Details

I. General information

NPI: 1497281125
Provider Name (Legal Business Name): JEREMY WENNING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W BROAD ST
GALLOWAY OH
43119-9531
US

IV. Provider business mailing address

5800 W BROAD ST
GALLOWAY OH
43119-9531
US

V. Phone/Fax

Practice location:
  • Phone: 614-870-4354
  • Fax: 614-870-4541
Mailing address:
  • Phone: 614-870-4354
  • Fax: 614-870-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03223664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: