Healthcare Provider Details

I. General information

NPI: 1972103786
Provider Name (Legal Business Name): JAN RENEE KALK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAN RENEE ECKERLE RPH

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 N GOSPEL ST
PAOLI IN
47454-1419
US

IV. Provider business mailing address

5868 W RILLA MAE RD
TASWELL IN
47175-7123
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-3944
  • Fax:
Mailing address:
  • Phone: 812-613-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26017238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: