Provider Demographics
NPI:1811583115
Name:FAJARDO, LENA JOHANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:JOHANNA
Last Name:FAJARDO
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 1:273 PORTAGE TRAIL EXT W
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3613
Mailing Address - Country:US
Mailing Address - Phone:331-442-1211
Mailing Address - Fax:
Practice Address - Street 1:6421 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2490
Practice Address - Country:US
Practice Address - Phone:330-244-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist