Provider Demographics
NPI:1669758249
Name:KREITZER, JEFFREY RYAN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RYAN
Last Name:KREITZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3887 DRAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2125
Mailing Address - Country:US
Mailing Address - Phone:513-288-6161
Mailing Address - Fax:
Practice Address - Street 1:9 W MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1525
Practice Address - Country:US
Practice Address - Phone:513-646-1242
Practice Address - Fax:513-641-0841
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist