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General NPI Number Information
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NPI Number | 1114806338
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Entity Type | Individual
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Provider Name | JEFF MEZZONE
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Gender |
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 530 S JACKSON ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1675
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Country | US
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Telephone | 502-562-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 7731 UPTON OXMOOR LN APT 211
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City | LOUISVILLE
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State | KY
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Zip | 40222-3432
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Country | US
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Telephone | 210-379-5953
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 024600
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License Number State | KY
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