Healthcare Provider Details

I. General information

NPI: 1811736416
Provider Name (Legal Business Name): MARYAM JAAFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 06/29/2026
Certification Date: 05/22/2024
Deactivation Date: 12/28/2024
Reactivation Date: 06/29/2026

III. Provider practice location address

2565 E MAIN ST
SPRINGFIELD OH
45503-4915
US

IV. Provider business mailing address

2565 E MAIN ST
SPRINGFIELD OH
45503-4915
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-6423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: