Provider Demographics
NPI:1356031041
Name:BLACKSTEN, JOLEEN VONNEE (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:JOLEEN
Middle Name:VONNEE
Last Name:BLACKSTEN
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NARRAGANSETT RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9662
Mailing Address - Country:US
Mailing Address - Phone:740-334-7042
Mailing Address - Fax:
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3699
Practice Address - Country:US
Practice Address - Phone:220-564-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03320125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist