Provider Demographics
NPI:1790198331
Name:JABLONSKI, ALYSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 MIDDLE BR
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9383
Mailing Address - Country:US
Mailing Address - Phone:440-669-0838
Mailing Address - Fax:
Practice Address - Street 1:7504 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1524
Practice Address - Country:US
Practice Address - Phone:419-841-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist