Provider Demographics
NPI:1326543224
Name:JABLONSKI, GARY WILLIAMS (RPH)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WILLIAMS
Last Name:JABLONSKI
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 1:5100 E BELTLINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1006
Mailing Address - Country:US
Mailing Address - Phone:616-361-1758
Mailing Address - Fax:616-391-8852
Practice Address - Street 1:5100 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1006
Practice Address - Country:US
Practice Address - Phone:616-361-1758
Practice Address - Fax:616-391-8852
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist