Healthcare Provider Details

I. General information

NPI: 1114730090
Provider Name (Legal Business Name): JONATHAN REDLINSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 WOOD STREET
WRANGELL AK
99929
US

IV. Provider business mailing address

4644 ECKHARDT RD
EDEN NY
14057-9751
US

V. Phone/Fax

Practice location:
  • Phone: 907-874-5005
  • Fax: 907-600-5105
Mailing address:
  • Phone: 716-597-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number126105
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: