Healthcare Provider Details

I. General information

NPI: 1376787317
Provider Name (Legal Business Name): JEFFREY L MUSZYNSKI R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 LOUISIANA AVE
PERRYSBURG OH
43551-2537
US

IV. Provider business mailing address

1175 LOUISIANA AVE
PERRYSBURG OH
43551-2537
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-3587
  • Fax: 419-874-4538
Mailing address:
  • Phone: 419-874-3587
  • Fax: 419-874-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03213253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: