Healthcare Provider Details

I. General information

NPI: 1457624504
Provider Name (Legal Business Name): JENNIFER L RICHARDSON PHARMD, BCPS, CACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 W. SYLVANIA AVENUE MERCY ST. ANNE HOSPITAL
TOLEDO OH
43623
US

IV. Provider business mailing address

3404 W. SYLVANIA AVE MERCY ST. ANNE HOSPITAL
TOLEDO OH
43623
US

V. Phone/Fax

Practice location:
  • Phone: 419-407-2118
  • Fax: 419-407-3824
Mailing address:
  • Phone: 419-407-2118
  • Fax: 419-407-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03223395
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS49909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: