Healthcare Provider Details

I. General information

NPI: 1225865843
Provider Name (Legal Business Name): OLIVIA JOLEEN-SAGE KOEPKE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 PENFIELD RD
PENFIELD NY
14526-1793
US

IV. Provider business mailing address

532 HELENDALE RD
ROCHESTER NY
14609-3116
US

V. Phone/Fax

Practice location:
  • Phone: 585-248-3060
  • Fax:
Mailing address:
  • Phone: 585-278-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: