1982011094 NPI number — DR. LEAH MAY BIERLEY JAHAHN PHARMD

Table of content: DR. LEAH MAY BIERLEY JAHAHN PHARMD (NPI 1982011094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982011094 NPI number — DR. LEAH MAY BIERLEY JAHAHN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAHAHN
Provider First Name:
LEAH
Provider Middle Name:
MAY BIERLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIERLEY
Provider Other First Name:
LEAH
Provider Other Middle Name:
MAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982011094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2929 WALKER NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-681-2410
Provider Business Mailing Address Fax Number:
740-681-2465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 EAST BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REYNOLDSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-322-7410
Provider Business Practice Location Address Fax Number:
614-322-7465
Provider Enumeration Date:
07/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  03233773 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0168545 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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