=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245584820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL MARIE VON TIEHL RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2012
-----------------------------------------------------
Last Update Date | 11/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 MACK RD PHARMACY DEPT.
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45014-5335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-682-1193
-----------------------------------------------------
Fax | 513-682-1194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8212 INDIAN TRAIL DR
-----------------------------------------------------
City | MADEIRA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45243-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-477-8403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03325753
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 56956
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------