Provider Demographics
NPI:1366302093
Name:FORDYCE, JAY (RPH)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:
Last Name:FORDYCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 HAZELBRUSH RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9558
Mailing Address - Country:US
Mailing Address - Phone:419-935-6211
Mailing Address - Fax:419-935-4018
Practice Address - Street 1:307 W WALTON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9133
Practice Address - Country:US
Practice Address - Phone:419-935-6211
Practice Address - Fax:419-935-4018
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist