Healthcare Provider Details

I. General information

NPI: 1225626922
Provider Name (Legal Business Name): JACOB ZOLNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 LEIBY OSBORNE RD
SOUTHINGTON OH
44470-9510
US

IV. Provider business mailing address

2114 LEIBY OSBORNE RD
SOUTHINGTON OH
44470-9510
US

V. Phone/Fax

Practice location:
  • Phone: 330-307-9700
  • Fax:
Mailing address:
  • Phone: 330-307-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03440400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: