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General NPI Number Information
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NPI Number | 1952002040
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Entity Type | Individual
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Provider Name | MR. JACOB CHARLES GEBHART
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Gender | Male
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 421 N HIGH ST
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City | HILLSBORO
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State | OH
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Zip | 45133-1132
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Country | US
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Telephone | 937-393-1734
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 497
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City | LEESBURG
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State | OH
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Zip | 45135-0497
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Country | US
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Telephone | 937-661-4336
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 09200241
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License Number State | OH
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