Healthcare Provider Details

I. General information

NPI: 1952904559
Provider Name (Legal Business Name): JACOB METZGER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 W 4TH ST
ONTARIO OH
44906-1945
US

IV. Provider business mailing address

1258 TOWNSHIP ROAD 1536
ASHLAND OH
44805-9739
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-6001
  • Fax: 419-529-9743
Mailing address:
  • Phone: 419-544-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03129579
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: