Provider Demographics
NPI:1578195863
Name:GEDULDIG, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:GEDULDIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6959 CRYSTAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2173
Mailing Address - Country:US
Mailing Address - Phone:440-241-9219
Mailing Address - Fax:
Practice Address - Street 1:6959 CRYSTAL CREEK DR
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2173
Practice Address - Country:US
Practice Address - Phone:440-241-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist