Provider Demographics
NPI:1952002040
Name:GEBHART, JACOB CHARLES
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:CHARLES
Last Name:GEBHART
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:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-0497
Mailing Address - Country:US
Mailing Address - Phone:937-661-4336
Mailing Address - Fax:
Practice Address - Street 1:421 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1132
Practice Address - Country:US
Practice Address - Phone:937-393-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09200241183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician