MEDICARE: DR. JASON JANIDLO PHARM.D.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	03331379	OH

General Provider Information

NPI Number	:	1285915892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON JANIDLO PHARM.D.

Provider Business Mailing Address
First Line	:	555 W MARION RD
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1025
Country	:	US
Telephone Number	:	419-947-9134
Fax Number	:	419-947-1304

Provider Business Practice Location Address
First Line	:	555 W MARION RD
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1025
Country	:	US
Telephone Number	:	419-947-9134
Fax Number	:	419-947-1304

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	05/10/2026

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