Provider Demographics
NPI:1659582849
Name:JABLONSKI, GERALD J
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:JABLONSKI
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 1:3832 W 61ST PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4615
Mailing Address - Country:US
Mailing Address - Phone:773-585-8907
Mailing Address - Fax:
Practice Address - Street 1:3832 W 61ST PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4615
Practice Address - Country:US
Practice Address - Phone:773-585-8907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist