Individual
JACY CHRISTENA THEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
859 E MAIN ST, LANCASTER, OH 43130-3940
(740) 654-2592
Mailing address
4649 WINTERSET DR, COLUMBUS, OH 43220-8112
(330) 435-5037
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03439647
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03439647
OHIO PHARMACIST LICENSE NUMBER
OH
Enumeration date
09/24/2020
Last updated
09/24/2020
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