Provider Demographics
NPI:1790915452
Name:POLZIN, JEFF BRIAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:BRIAN
Last Name:POLZIN
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 1:6555 TOWNSHIP ROAD 199
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9698
Mailing Address - Country:US
Mailing Address - Phone:740-817-2349
Mailing Address - Fax:
Practice Address - Street 1:7826 STRATHMOORE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9253
Practice Address - Country:US
Practice Address - Phone:614-214-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324134183500000X
NV14929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist