Provider Demographics
NPI:1780895144
Name:KENZIK, ASHLEY JO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:JO
Last Name:KENZIK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33286 FAIRPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012
Mailing Address - Country:US
Mailing Address - Phone:440-506-1796
Mailing Address - Fax:
Practice Address - Street 1:2853 GROVE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2041
Practice Address - Country:US
Practice Address - Phone:440-277-6181
Practice Address - Fax:440-240-6576
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-26138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist