Provider Demographics
NPI:1619277126
Name:PREBILSKY, JACK CRAIG (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:CRAIG
Last Name:PREBILSKY
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 1:5660 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1215
Mailing Address - Country:US
Mailing Address - Phone:503-364-1520
Mailing Address - Fax:503-391-9302
Practice Address - Street 1:5660 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1215
Practice Address - Country:US
Practice Address - Phone:503-364-1520
Practice Address - Fax:503-391-9302
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist