Provider Demographics
NPI:1619577632
Name:OBLACZYNSKI, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:OBLACZYNSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1693 STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8265
Mailing Address - Country:US
Mailing Address - Phone:614-539-8610
Mailing Address - Fax:614-539-8620
Practice Address - Street 1:1693 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8265
Practice Address - Country:US
Practice Address - Phone:614-539-8610
Practice Address - Fax:614-539-8620
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03224888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist