Provider Demographics
NPI:1528398740
Name:JASENSKY, RONALD (RPH PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:JASENSKY
Suffix:
Gender:M
Credentials:RPH PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 W SAINT MARYS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3107
Mailing Address - Country:US
Mailing Address - Phone:520-622-2393
Mailing Address - Fax:
Practice Address - Street 1:1549 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-3107
Practice Address - Country:US
Practice Address - Phone:520-622-2393
Practice Address - Fax:520-622-0479
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist