Provider Demographics
NPI:1629524350
Name:CULLER, JAY (RPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:CULLER
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 1:1291 CRESTVIEW AVE SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663
Mailing Address - Country:US
Mailing Address - Phone:330-243-0382
Mailing Address - Fax:
Practice Address - Street 1:735 N. WATER ST.
Practice Address - Street 2:
Practice Address - City:UHRICHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44683
Practice Address - Country:UM
Practice Address - Phone:740-922-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23-1940651OtherFEDERAL TAX ID NUMBER