=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306087911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA JANE KEHOE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2009
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 S WEST ST
-----------------------------------------------------
City | WAUPUN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53963-1681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-324-1600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3084 SUNDOWN CT
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52001-0831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-690-1696
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 19991
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14320
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------