Provider Demographics
NPI:1811386816
Name:JAGELSKI, PATRICIA (RPH)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:JAGELSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HARWOOD HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3411
Mailing Address - Country:US
Mailing Address - Phone:708-867-8564
Mailing Address - Fax:708-867-8586
Practice Address - Street 1:7401 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-3411
Practice Address - Country:US
Practice Address - Phone:708-867-8564
Practice Address - Fax:708-867-8586
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-033170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist