Provider Demographics
NPI:1548841505
Name:MILOWICKI, JESSE ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:ROBERT
Last Name:MILOWICKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1217
Mailing Address - Country:US
Mailing Address - Phone:304-527-1004
Mailing Address - Fax:304-527-1006
Practice Address - Street 1:1415 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1217
Practice Address - Country:US
Practice Address - Phone:307-527-1004
Practice Address - Fax:304-527-1006
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132492183500000X
WVRP0012554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist