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General NPI Number Information
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NPI Number | 1134716186
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Entity Type | Individual
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Provider Name | JERRY SIEGEL PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 8467 E MAIN ST
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-4707
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Country | US
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Telephone | 614-863-2000
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Fax | 614-863-2000
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Provider Business Mailing Address
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Address Line | 374 LYTTON WAY
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City | GAHANNA
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State | OH
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Zip | 43230-3331
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Country | US
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Telephone | 614-783-8582
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03311879
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License Number State | OH
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