Provider Demographics
NPI:1144590241
Name:GOLEMBIEWSKI, JON JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:JAY
Last Name:GOLEMBIEWSKI
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 1:4688 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2509
Mailing Address - Country:US
Mailing Address - Phone:414-303-6237
Mailing Address - Fax:
Practice Address - Street 1:4688 S 108TH ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2509
Practice Address - Country:US
Practice Address - Phone:414-303-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8575-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist