Healthcare Provider Details

I. General information

NPI: 1396034948
Provider Name (Legal Business Name): JESSICA ANN REISING RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 HIGH STREET
WADSWORTH OH
44281
US

IV. Provider business mailing address

2441 GRANGER ROAD
MEDINA OH
44256-8622
US

V. Phone/Fax

Practice location:
  • Phone: 330-336-2550
  • Fax:
Mailing address:
  • Phone: 330-391-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03122742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: