Healthcare Provider Details

I. General information

NPI: 1730099276
Provider Name (Legal Business Name): CHRISTINE WIDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 WOOSTER ST
LODI OH
44254-1351
US

IV. Provider business mailing address

661 WOOSTER ST
LODI OH
44254-1351
US

V. Phone/Fax

Practice location:
  • Phone: 330-948-0520
  • Fax: 330-948-0522
Mailing address:
  • Phone: 330-948-0520
  • Fax: 330-948-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03324182
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: