Provider Demographics
NPI:1083218663
Name:CZUBA, JEFFREY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:CZUBA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 CHEROKEE PATH
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3328
Mailing Address - Country:US
Mailing Address - Phone:440-787-4182
Mailing Address - Fax:
Practice Address - Street 1:2007 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5813
Practice Address - Country:US
Practice Address - Phone:216-351-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist