Provider Demographics
NPI:1598040198
Name:PAELTZ, JAY C
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:PAELTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 BRANCH HILL-GUINEA PIKE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-697-6574
Mailing Address - Fax:513-697-1524
Practice Address - Street 1:6385 BRANCH HILL-GUINEA PIKE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140
Practice Address - Country:US
Practice Address - Phone:513-697-6574
Practice Address - Fax:513-697-1524
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH033183313OtherOHIO STATE BOARD OF PHARMACY
OHRU166406OtherSTATE OF OHIO DRIVERS LICENSE