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General NPI Number Information
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NPI Number | 1154200806
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Entity Type | Individual
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Provider Name | JORDANNE BLANCHE KOULONG KUEMENE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1950 E FRY BLVD
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2705
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Country | US
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Telephone | 520-458-5638
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Fax |
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Provider Business Mailing Address
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Address Line | 1232 E SILVER ST
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City | TUCSON
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State | AZ
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Zip | 85719-3148
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S027619
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License Number State | AZ
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