MEDICARE: JILLIAN KAY KOEHN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S021722	AZ

General Provider Information

NPI Number	:	1275291726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN KAY KOEHN PHARMD

Provider Business Mailing Address
First Line	:	700 PALMER LN
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-8111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 HIGHWAY 95
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-6902
Country	:	US
Telephone Number	:	928-763-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	12/02/2021

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Directions to “ JILLIAN KAY KOEHN PHARMD” Practice Location

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