=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891399044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY GERARD METZ RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2020
-----------------------------------------------------
Last Update Date | 11/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 BEECHMONT AVE # 6123
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-231-4592
-----------------------------------------------------
Fax | 513-231-0623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 STRATHCOMA DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-703-1216
-----------------------------------------------------
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 | 03314283
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------