Healthcare Provider Details

I. General information

NPI: 1083380570
Provider Name (Legal Business Name): JENICA SMITH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 GLENDALE AVE
TOLEDO OH
43614-2648
US

IV. Provider business mailing address

18741 MERCER RD
BOWLING GREEN OH
43402-9282
US

V. Phone/Fax

Practice location:
  • Phone: 419-385-4675
  • Fax:
Mailing address:
  • Phone: 419-835-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03440736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: