Active NPI
Jordan Wollenberg
- Pharmacist
- Canal Winchester, OH
National Provider Identifier
1710413711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03230301
- Practice address
- 6095 Gender Rd
Canal Winchester, OH 43110-2014 - Phone
- (614) 834-2805
- Fax
- (614) 417-0016
- NPI assigned
- May 11, 2017
- Sex
- Female
- 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 | 03230301 | OH | Primary |
Addresses
Primary practice location
6095 Gender Rd
Canal Winchester, OH 43110-2014
Mailing address
6095 Gender Rd
Canal Winchester, OH 43110
Phone (614) 834-2805
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
| License | State | Type | Specialty |
|---|---|---|---|
| 03230301 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1710413711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6095 GENDER RD",
"city": "CANAL WINCHESTER",
"state": "OH",
"postal_code": "43110",
"telephone_number": "614-834-2805",
"fax_number": "614-417-0016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6095 GENDER RD",
"city": "CANAL WINCHESTER",
"state": "OH",
"postal_code": "431102014",
"telephone_number": "614-834-2805",
"fax_number": "614-417-0016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLLENBERG",
"first_name": "JORDAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-11",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03230301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canal Winchester, OH
- Winchester Place Health Care LLC (Winchester Place Nursing and Rehabilitation Center)
- Winchester Place Leasing, LLC
- Winchester Vision Care Inc
- Ashanta Wintons, STNA
- Brian Frederick Witte, D.O.
- Johniece Roberta Woodward, STNA
- Amanda Dawn Wright
- Cassandra Wright, PHARMD
- Xtra Comfort Home Health Care
- Tammie Diane Yancey, LCPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.