MEDICARE: MR. JEROME L TRUESDELL R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-2-11189	OH

General Provider Information

NPI Number	:	1053415232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEROME L TRUESDELL R.PH

Provider Business Mailing Address
First Line	:	3101 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3014
Country	:	US
Telephone Number	:	513-357-7289
Fax Number	:	513-357-7396

Provider Business Practice Location Address
First Line	:	5818 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1708
Country	:	US
Telephone Number	:	513-263-8750
Fax Number	:	513-263-8787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/08/2007

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