Healthcare Provider Details

I. General information

NPI: 1750817706
Provider Name (Legal Business Name): PAMELA UNDERWOOD RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E AIRPORT HWY
SWANTON OH
43558-1408
US

IV. Provider business mailing address

113 E AIRPORT HWY
SWANTON OH
43558-1408
US

V. Phone/Fax

Practice location:
  • Phone: 419-825-1475
  • Fax: 419-825-1133
Mailing address:
  • Phone: 419-825-1475
  • Fax: 419-825-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03223159
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: