Provider Demographics
NPI:1932719309
Name:JILEK, SUSAN E (RPH, BCNSP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:JILEK
Suffix:
Gender:F
Credentials:RPH, BCNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-591-3817
Mailing Address - Fax:
Practice Address - Street 1:1600 E RIVERVIEW AVE STE 109
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9805
Practice Address - Country:US
Practice Address - Phone:419-591-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-183921835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care