Healthcare Provider Details

I. General information

NPI: 1679857866
Provider Name (Legal Business Name): JANA FRANCES KOCHANNY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S MITCHELL ST
CADILLAC MI
49601-2510
US

IV. Provider business mailing address

23297 MACKINAW TRL
TUSTIN MI
49688-8307
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6383
  • Fax: 231-775-6546
Mailing address:
  • Phone: 231-775-6383
  • Fax: 231-775-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302031482
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: