Provider Demographics
NPI:1730462680
Name:GIVENS, JEFFERY DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DAVID
Last Name:GIVENS
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 1:2086 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4003
Mailing Address - Country:US
Mailing Address - Phone:330-688-4372
Mailing Address - Fax:330-688-4916
Practice Address - Street 1:2086 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4003
Practice Address - Country:US
Practice Address - Phone:330-688-4372
Practice Address - Fax:330-688-4916
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03322145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist