Healthcare Provider Details

I. General information

NPI: 1215504048
Provider Name (Legal Business Name): DAVID E HEGEMIER R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7389
  • Fax: 419-696-7371
Mailing address:
  • Phone: 419-696-7389
  • Fax: 419-696-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03114783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: