Provider Demographics
NPI:1285221119
Name:MERRILL, JENA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:NICOLE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:NICOLE
Other - Last Name:DENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1721 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3534
Mailing Address - Country:US
Mailing Address - Phone:419-234-5079
Mailing Address - Fax:
Practice Address - Street 1:8467 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4707
Practice Address - Country:US
Practice Address - Phone:419-234-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist