Provider Demographics
NPI:1386042687
Name:BJERKE, KEVIN D (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:BJERKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N 12TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1306
Mailing Address - Country:US
Mailing Address - Phone:414-219-3033
Mailing Address - Fax:414-219-7023
Practice Address - Street 1:950 N 12TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1306
Practice Address - Country:US
Practice Address - Phone:414-219-3033
Practice Address - Fax:414-219-7023
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10496-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist