Provider Demographics
NPI:1780804518
Name:JASTRZEMBOWSKI, JOSEPH JAY (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JAY
Last Name:JASTRZEMBOWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 LAKEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MI
Mailing Address - Zip Code:48655-8575
Mailing Address - Country:US
Mailing Address - Phone:989-865-9899
Mailing Address - Fax:
Practice Address - Street 1:309 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1113
Practice Address - Country:US
Practice Address - Phone:989-652-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist