Provider Demographics
NPI:1760091375
Name:JAKUTOWICZ, MICHELE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:JAKUTOWICZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9399
Mailing Address - Country:US
Mailing Address - Phone:419-343-2950
Mailing Address - Fax:
Practice Address - Street 1:1600 E RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9805
Practice Address - Country:US
Practice Address - Phone:419-591-3817
Practice Address - Fax:419-591-3875
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist