Provider Demographics
NPI:1376377390
Name:WENTWORTH, LUCY ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:ROSE
Last Name:WENTWORTH
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 1:3688 BRINELL ST W APT 407
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3787
Mailing Address - Country:US
Mailing Address - Phone:614-580-9677
Mailing Address - Fax:
Practice Address - Street 1:5383 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1502
Practice Address - Country:US
Practice Address - Phone:614-771-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist