Basic Information
| Provider Information | |||||||||
| NPI: | 1306437538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVITAN | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436045827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1419349779 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1415 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436045827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192145740 | ||||||||
| FaxNumber: | 4192420421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2021 | ||||||||
| LastUpdateDate: | 01/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03029419 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.