Provider Demographics
NPI:1861087447
Name:MYERS, JONATHON M (RPH)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:M
Last Name:MYERS
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 1:116 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43526-1173
Mailing Address - Country:US
Mailing Address - Phone:419-542-6218
Mailing Address - Fax:
Practice Address - Street 1:116 E HIGH ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43526-1173
Practice Address - Country:US
Practice Address - Phone:419-542-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist