Provider Demographics
NPI:1053917872
Name:GULLETT, JONATHAN W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:GULLETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2941
Mailing Address - Country:US
Mailing Address - Phone:614-695-9519
Mailing Address - Fax:
Practice Address - Street 1:262 NEIL AVE STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7319
Practice Address - Country:US
Practice Address - Phone:614-569-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist