Individual provider Active NPI

Jordan Vance Dewitt

  • Pharmacist
  • Columbus, OH
National Provider Identifier
1639793961
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
03334432 Issued in OH
Practice address
3535 Olentangy River Rd
Columbus, OH 43214-3908
Phone
(614) 566-2906
NPI assigned
Jun 2, 2020
Last updated
Jun 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 03334432 OH Primary

Addresses

Primary practice location

3535 Olentangy River Rd
Columbus, OH 43214-3908

Mailing address

2965 Indian Summer Dr
Galena, OH 43021-1104
Phone (740) 816-3238

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

State licenses

LicenseStateTypeSpecialty
03334432OHMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1639793961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 INDIAN SUMMER DR",
            "city": "GALENA",
            "state": "OH",
            "postal_code": "430211104",
            "telephone_number": "740-816-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 OLENTANGY RIVER RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143908",
            "telephone_number": "614-566-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWITT",
        "first_name": "JORDAN",
        "middle_name": "VANCE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-02",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03334432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.