Provider Demographics
NPI:1902304199
Name:LAMBERJACK, DAVID H
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:LAMBERJACK
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 1:1375 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1560
Mailing Address - Country:US
Mailing Address - Phone:614-488-4062
Mailing Address - Fax:614-487-4746
Practice Address - Street 1:1375 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1560
Practice Address - Country:US
Practice Address - Phone:614-488-4062
Practice Address - Fax:614-487-4746
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist