Provider Demographics
NPI:1811592173
Name:JELICH, JANA BELL
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:BELL
Last Name:JELICH
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 1:7081 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3712
Mailing Address - Country:US
Mailing Address - Phone:251-342-0948
Mailing Address - Fax:
Practice Address - Street 1:7081 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3712
Practice Address - Country:US
Practice Address - Phone:251-342-0948
Practice Address - Fax:251-342-0912
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist