Provider Demographics
NPI:1770254492
Name:O'NEILL, JANINE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:ANN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:ANN
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:11031 STATE ROUTE 212 NE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8744
Mailing Address - Country:US
Mailing Address - Phone:330-874-3723
Mailing Address - Fax:330-874-1184
Practice Address - Street 1:11031 STATE ROUTE 212 NE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-8744
Practice Address - Country:US
Practice Address - Phone:330-874-3723
Practice Address - Fax:330-874-1184
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist