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General NPI Number Information
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NPI Number | 1396114369
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Entity Type | Individual
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Provider Name | CHRISTINA KOUKOL PHARMD, RPH
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Gender | Female
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 609 N SPRING ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-2040
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Country | US
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Telephone | 920-885-3277
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Fax | 920-885-3570
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Provider Business Mailing Address
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Address Line | N9044 BASSWOOD RD
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City | BEAVER DAM
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State | WI
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Zip | 53916-9466
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Country | US
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Telephone | 815-323-3276
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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 | 14974-40
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License Number State | WI
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