Provider Demographics
NPI:1982306965
Name:WORTMAN, TABITHA JILL
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:JILL
Last Name:WORTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TABITHA
Other - Middle Name:JILL
Other - Last Name:HOFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1336
Mailing Address - Country:US
Mailing Address - Phone:419-884-6107
Mailing Address - Fax:419-886-6220
Practice Address - Street 1:355 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1336
Practice Address - Country:US
Practice Address - Phone:419-884-6107
Practice Address - Fax:419-884-6220
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09317579183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician