Healthcare Provider Details

I. General information

NPI: 1629693775
Provider Name (Legal Business Name): MARLIES JOCELYN JERIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 JACKMAN RD
TOLEDO OH
43613-3574
US

IV. Provider business mailing address

7336 VIOLET LN
MAUMEE OH
43537-9056
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-9103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03438707
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: