Provider Demographics
NPI:1245584820
Name:VON TIEHL, JILL MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:VON TIEHL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:TARTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:8212 INDIAN TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1400
Mailing Address - Country:US
Mailing Address - Phone:440-477-8403
Mailing Address - Fax:
Practice Address - Street 1:3000 MACK RD
Practice Address - Street 2:PHARMACY DEPT.
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5335
Practice Address - Country:US
Practice Address - Phone:513-682-1193
Practice Address - Fax:513-682-1194
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325753183500000X
CA56956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist