=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871624262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA SUE KERNIEN RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3524 E MILWAUKEE ST
-----------------------------------------------------
City | JANESVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53546-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-754-5194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7370 N CURHARKEN CT
-----------------------------------------------------
City | EDGERTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53534-9765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-868-1705
-----------------------------------------------------
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 | 10076
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------