Provider Demographics
NPI:1477089035
Name:BIGELOW, JEB (RPH)
Entity Type:Individual
Prefix:
First Name:JEB
Middle Name:
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8666
Mailing Address - Country:US
Mailing Address - Phone:614-759-2765
Mailing Address - Fax:614-522-5580
Practice Address - Street 1:1045 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8666
Practice Address - Country:US
Practice Address - Phone:614-759-2765
Practice Address - Fax:614-522-5580
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist