Provider Demographics
NPI:1902461122
Name:HART, JEANNINE EILEEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:EILEEN
Last Name:HART
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PARKTRAIL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-6289
Mailing Address - Country:US
Mailing Address - Phone:513-708-4641
Mailing Address - Fax:
Practice Address - Street 1:300 PARKTRAIL LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-6289
Practice Address - Country:US
Practice Address - Phone:513-708-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031189261835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy