Provider Demographics
NPI:1699984187
Name:BURKHOLDER, JONESSA LYNNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONESSA
Middle Name:LYNNE
Last Name:BURKHOLDER
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 1:16495 FREED ST SE
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-9106
Mailing Address - Country:US
Mailing Address - Phone:330-868-7063
Mailing Address - Fax:
Practice Address - Street 1:7844 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9396
Practice Address - Country:US
Practice Address - Phone:330-424-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-27189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist