Provider Demographics
NPI:1760548119
Name:JABLENSKI, JANIS E (CPHT)
Entity Type:Individual
Prefix:MS
First Name:JANIS
Middle Name:E
Last Name:JABLENSKI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 W MAZATZAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86413-8959
Mailing Address - Country:US
Mailing Address - Phone:928-897-1769
Mailing Address - Fax:
Practice Address - Street 1:3269 STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3619
Practice Address - Country:US
Practice Address - Phone:928-757-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4345183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician