Healthcare Provider Details

I. General information

NPI: 1275291726
Provider Name (Legal Business Name): JILLIAN KAY KOEHN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN KAY CORBETT PHARMD

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 ACOMA BLVD N
LAKE HAVASU CITY AZ
86403-6932
US

IV. Provider business mailing address

700 PALMER LN
LAKE HAVASU CITY AZ
86406-8111
US

V. Phone/Fax

Practice location:
  • Phone: 928-680-4449
  • Fax: 928-680-6122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021722
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS021722
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: