Provider Demographics
NPI:1811559164
Name:JABLONSKI, JILLIAN LISA
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LISA
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27284 NORMA DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-8317
Mailing Address - Country:US
Mailing Address - Phone:586-707-0551
Mailing Address - Fax:
Practice Address - Street 1:4110 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2501
Practice Address - Country:US
Practice Address - Phone:586-765-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist