MEDICARE: JENA CHRISTOPHERSON

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	17260-40	WI

General Provider Information

NPI Number	:	1487089603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENA CHRISTOPHERSON

Provider Business Mailing Address
First Line	:	1501 MILLER PARK WAY
Second Line	:
City	:	WEST MILWAUKEE
State	:	WI
Zip	:	53214-3654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 MILLER PARK WAY
Second Line	:
City	:	WEST MILWAUKEE
State	:	WI
Zip	:	53214-3654
Country	:	US
Telephone Number	:	414-203-0107
Fax Number	:

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

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	09/06/2013

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