=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679857866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANA FRANCES KOCHANNY RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2011
-----------------------------------------------------
Last Update Date | 10/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 S MITCHELL ST
-----------------------------------------------------
City | CADILLAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49601-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-775-6383
-----------------------------------------------------
Fax | 231-775-6546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23297 MACKINAW TRL
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49688-8307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-775-6383
-----------------------------------------------------
Fax | 231-775-6543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302031482
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------