Provider Demographics
NPI:1396454401
Name:NESAMONY, JERRY (RPH)
Entity type:Individual
Prefix:PROF
First Name:JERRY
Middle Name:
Last Name:NESAMONY
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 1:26365 SPRING TRACE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6414
Mailing Address - Country:US
Mailing Address - Phone:419-868-4839
Mailing Address - Fax:
Practice Address - Street 1:26365 SPRING TRACE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-6414
Practice Address - Country:US
Practice Address - Phone:419-868-4839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist