Provider Demographics
NPI:1104125434
Name:KROSNICK, JAY E (RPH)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:E
Last Name:KROSNICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 CRESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1606
Mailing Address - Country:US
Mailing Address - Phone:301-704-4978
Mailing Address - Fax:
Practice Address - Street 1:1601 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3035
Practice Address - Country:US
Practice Address - Phone:202-588-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2202183500000X
MD10544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10544OtherPHARMACIST LICENSE
DCPH2202OtherPHARMACIST LICENSE