Provider Demographics
NPI:1154468353
Name:YINGLING, JEANETTE L (RPH)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:L
Last Name:YINGLING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JEANETTE
Other - Middle Name:L
Other - Last Name:KANTZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9766 COBBLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-6101
Mailing Address - Country:US
Mailing Address - Phone:937-434-5330
Mailing Address - Fax:
Practice Address - Street 1:1141 N MONROE DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1619
Practice Address - Country:US
Practice Address - Phone:937-352-2090
Practice Address - Fax:937-352-3090
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-21906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist