Healthcare Provider Details

I. General information

NPI: 1831576214
Provider Name (Legal Business Name): JENNIFER KUPCZYK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36745 AIKEN RD
BAYFIELD WI
54814-4579
US

IV. Provider business mailing address

36745 AIKEN RD
BAYFIELD WI
54814-4579
US

V. Phone/Fax

Practice location:
  • Phone: 715-779-3157
  • Fax: 715-779-3752
Mailing address:
  • Phone: 715-779-3157
  • Fax: 715-779-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13883-40
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302039798
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: