Healthcare Provider Details

I. General information

NPI: 1770254401
Provider Name (Legal Business Name): JEANNINE WEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W MAPLE ST
HARTVILLE OH
44632-9088
US

IV. Provider business mailing address

907 W MAPLE ST
HARTVILLE OH
44632-9088
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-0221
  • Fax:
Mailing address:
  • Phone: 330-877-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03221604
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040545R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: