Provider Demographics
NPI:1568120814
Name:SCHLICHT, JEDD
Entity Type:Individual
Prefix:
First Name:JEDD
Middle Name:
Last Name:SCHLICHT
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JEDD
Other - Middle Name:
Other - Last Name:SCHLICHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:780 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1610
Mailing Address - Country:US
Mailing Address - Phone:330-336-2550
Mailing Address - Fax:
Practice Address - Street 1:780 HIGH ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1610
Practice Address - Country:US
Practice Address - Phone:330-336-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist