Provider Demographics
NPI:1053911610
Name:RUSHLEY, JESSICA FRATINO
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRATINO
Last Name:RUSHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 KENTON TRL
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6340
Mailing Address - Country:US
Mailing Address - Phone:614-329-3934
Mailing Address - Fax:
Practice Address - Street 1:10392 FREMONT PIKE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3335
Practice Address - Country:US
Practice Address - Phone:419-874-0571
Practice Address - Fax:419-874-0587
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3232543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist