Provider Demographics
NPI:1649944950
Name:ANDERSON, JAMIE CHARTON (RPH)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:CHARTON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MCMILLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1809
Mailing Address - Country:US
Mailing Address - Phone:220-564-1898
Mailing Address - Fax:220-564-1899
Practice Address - Street 1:88 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1809
Practice Address - Country:US
Practice Address - Phone:220-564-1898
Practice Address - Fax:220-564-1899
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-178321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-2-17832Medicaid