Healthcare Provider Details

I. General information

NPI: 1770494122
Provider Name (Legal Business Name): JONATHAN DANIEL GOETSCH PHARMD, MHSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

104 MAPLE AVE APT 2
GREENVILLE PA
16125-7907
US

V. Phone/Fax

Practice location:
  • Phone: 815-593-1071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446949
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: