Provider Demographics
NPI:1184832412
Name:KESSLER, JACLYN MARIE
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:MARIE
Last Name:KESSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S STATE ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:OH
Mailing Address - Zip Code:44867-9747
Mailing Address - Country:US
Mailing Address - Phone:419-585-4964
Mailing Address - Fax:
Practice Address - Street 1:2826 E HARBOR RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2611
Practice Address - Country:US
Practice Address - Phone:419-732-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06005382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist