MEDICARE: MR. JOSEPH JAY JASTRZEMBOWSKI RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302028879	MI

General Provider Information

NPI Number	:	1780804518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH JAY JASTRZEMBOWSKI RPH.

Provider Business Mailing Address
First Line	:	11730 LAKEFIELD RD
Second Line	:
City	:	SAINT CHARLES
State	:	MI
Zip	:	48655-8575
Country	:	US
Telephone Number	:	989-865-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 N MAIN ST
Second Line	:
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-1113
Country	:	US
Telephone Number	:	989-652-2613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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