MEDICARE: ANDREA JO KOOIKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	011701	KY

General Provider Information

NPI Number	:	1144927104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA JO KOOIKER

Provider Business Mailing Address
First Line	:	927 LOWER COLESBURG RD
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-6181
Country	:	US
Telephone Number	:	270-300-4175
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 BINTER ST
Second Line	:
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5160
Country	:	US
Telephone Number	:	502-624-9222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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