MEDICARE: JENICA BECK RPH

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	03440736	OH

General Provider Information

NPI Number	:	1083380570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENICA BECK RPH

Provider Business Mailing Address
First Line	:	168 OAK ST
Second Line	:
City	:	ROSSFORD
State	:	OH
Zip	:	43460-1233
Country	:	US
Telephone Number	:	419-835-4260
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 GLENDALE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2648
Country	:	US
Telephone Number	:	419-385-4675
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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