Provider Demographics
NPI:1275291726
Name:KOEHN, JILLIAN KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:KAY
Last Name:KOEHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:KAY
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:700 PALMER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-8111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1751 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6902
Practice Address - Country:US
Practice Address - Phone:928-763-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist