Healthcare Provider Details

I. General information

NPI: 1154340974
Provider Name (Legal Business Name): JENNIFER ANN KOCH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE CS-119 (PHARMACY)
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

2510 N 86TH ST
MILWAUKEE WI
53226-1922
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax: 414-389-4276
Mailing address:
  • Phone: 414-331-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13518 - 40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: