Healthcare Provider Details

I. General information

NPI: 1861572752
Provider Name (Legal Business Name): JANA JO KMOCH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 WESTVIEW PLZ NORTH HIGHWAY 83
MCCOOK NE
69001-4414
US

IV. Provider business mailing address

1611 CENTENNIAL DR
MCCOOK NE
69001-2739
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-5670
  • Fax: 308-345-5676
Mailing address:
  • Phone: 308-345-6359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11122
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: