Provider Demographics
NPI:1124116603
Name:FOLSTAD, JON EDWARD (PHARMD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:EDWARD
Last Name:FOLSTAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35900 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3117
Mailing Address - Country:US
Mailing Address - Phone:216-791-3800
Mailing Address - Fax:216-231-3291
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:LOUIS STOKES CLEVELAND VAMC (119W)
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-231-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03316842183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy