Provider Demographics
NPI:1124628862
Name:SOUDERS, JILLIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SOUDERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 DELMONT RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7858
Mailing Address - Country:US
Mailing Address - Phone:614-638-8713
Mailing Address - Fax:
Practice Address - Street 1:1470 S COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2165
Practice Address - Country:US
Practice Address - Phone:740-474-9898
Practice Address - Fax:740-477-6053
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist