Healthcare Provider Details

I. General information

NPI: 1629381546
Provider Name (Legal Business Name): JEREMY HANON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N RIVERCENTER DR
MILWAUKEE WI
53212-3978
US

IV. Provider business mailing address

1311 N 6TH ST
MILWAUKEE WI
53212-4006
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-1555
  • Fax:
Mailing address:
  • Phone: 414-223-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15637-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: