Provider Demographics
NPI:1992374748
Name:BANKY, JILLIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:BANKY
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 1:5752 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-9442
Mailing Address - Country:US
Mailing Address - Phone:419-283-2729
Mailing Address - Fax:
Practice Address - Street 1:1955 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2256
Practice Address - Country:US
Practice Address - Phone:330-262-9045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist