Provider Demographics
NPI:1528887619
Name:CIESLA, JONATHAN JEFFREY (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JEFFREY
Last Name:CIESLA
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTHBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2928
Mailing Address - Country:US
Mailing Address - Phone:937-369-8223
Mailing Address - Fax:
Practice Address - Street 1:4996 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6054
Practice Address - Country:US
Practice Address - Phone:937-233-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03444852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist