Provider Demographics
NPI:1619379773
Name:RANDAZZO, JACLYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:PURGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16751 LUCKY BELL LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5187
Mailing Address - Country:US
Mailing Address - Phone:216-339-1554
Mailing Address - Fax:
Practice Address - Street 1:6270 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2913
Practice Address - Country:US
Practice Address - Phone:440-836-0494
Practice Address - Fax:440-836-0498
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03233654OtherOHIO STATE BOARD OF PHARMACY
OH836738OtherNATIONAL ASSOCIATION OF BOARDS OF PHARMACY