Healthcare Provider Details

I. General information

NPI: 1245819523
Provider Name (Legal Business Name): ROBYN BRAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 HIGH ST # 33
WORTHINGTON OH
43085-4105
US

IV. Provider business mailing address

659 HIGH ST # 33
WORTHINGTON OH
43085-4105
US

V. Phone/Fax

Practice location:
  • Phone: 614-886-5436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03327012
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: