Healthcare Provider Details

I. General information

NPI: 1902304199
Provider Name (Legal Business Name): DAVID H LAMBERJACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DOC LAMBERJACK

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12116 SYCAMORE TRCE
PLAIN CITY OH
43064-4400
US

IV. Provider business mailing address

12116 SYCAMORE TRCE
PLAIN CITY OH
43064-4400
US

V. Phone/Fax

Practice location:
  • Phone: 614-504-4125
  • Fax: 614-504-0669
Mailing address:
  • Phone: 614-504-4125
  • Fax: 614-504-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-3-20049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: