Healthcare Provider Details

I. General information

NPI: 1487582466
Provider Name (Legal Business Name): JASELYNN D DE LUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BLACKBURN AVE
ASHLAND KY
41101-4503
US

IV. Provider business mailing address

933 BLACKBURN AVE
ASHLAND KY
41101-4503
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-0372
  • Fax:
Mailing address:
  • Phone: 606-324-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPO7951
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: