Active NPI
Jeffrey M. Walthour, PHARM.D.
- Pharmacist
- Mansfield, OH
National Provider Identifier
1124478425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03215737
- Practice address
- 770 Balgreen Dr
Suite 104
Mansfield, OH 44906-4106 - Phone
- (419) 526-8972
- Fax
- (419) 526-8974
- NPI assigned
- Jun 16, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03215737 | OH | Primary |
Addresses
Primary practice location
770 Balgreen Dr
Suite 104
Mansfield, OH 44906-4106
Mailing address
770 Balgreen Dr
Suite 104
Mansfield, OH 44906-4106
Phone (419) 526-8972
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03215737 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medcentral Health System | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Medical Laboratory
- Mansfield, OH
- NPI 1962888016
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466035200000",
"number": "1124478425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "770 BALGREEN DR",
"address_2": "SUITE 104",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449064106",
"telephone_number": "419-526-8972",
"fax_number": "419-526-8974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 BALGREEN DR",
"address_2": "SUITE 104",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449064106",
"telephone_number": "419-526-8972",
"fax_number": "419-526-8974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTHOUR",
"first_name": "JEFFREY",
"middle_name": "M.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-16",
"last_updated": "2016-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03215737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.