Healthcare Provider Details

I. General information

NPI: 1841182326
Provider Name (Legal Business Name): JASMIN ANN CHAKOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9942 SOUTHWYCK AVE NW
NORTH CANTON OH
44720-9837
US

IV. Provider business mailing address

9942 SOUTHWYCK AVE NW
NORTH CANTON OH
44720-9837
US

V. Phone/Fax

Practice location:
  • Phone: 330-531-0608
  • Fax:
Mailing address:
  • Phone: 330-531-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number09223677
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: