Provider Demographics
NPI:1972943009
Name:EBERT, JEREMY ALAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ALAN
Last Name:EBERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 AUTUMN DR
Mailing Address - Street 2:APT A
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1824
Mailing Address - Country:US
Mailing Address - Phone:419-569-3942
Mailing Address - Fax:
Practice Address - Street 1:730 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4602
Practice Address - Country:US
Practice Address - Phone:419-227-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist