Provider Demographics
NPI:1750836425
Name:SRDIC, JELENA (PHARMD)
Entity type:Individual
Prefix:
First Name:JELENA
Middle Name:
Last Name:SRDIC
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 1:7614 S TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6227
Mailing Address - Country:US
Mailing Address - Phone:440-862-0587
Mailing Address - Fax:
Practice Address - Street 1:16400 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-3714
Practice Address - Country:US
Practice Address - Phone:216-561-4007
Practice Address - Fax:216-561-7280
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist