Healthcare Provider Details

I. General information

NPI: 1699984187
Provider Name (Legal Business Name): JONESSA LYNNE BURKHOLDER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7844 STATE ROUTE 45
LISBON OH
44432-9396
US

IV. Provider business mailing address

16495 FREED ST SE
MINERVA OH
44657-9106
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-7743
  • Fax:
Mailing address:
  • Phone: 330-868-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-1-27189
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: