Provider Demographics
NPI:1558578567
Name:KOEHLER, JENNIFER S (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-8608
Mailing Address - Country:US
Mailing Address - Phone:360-988-5101
Mailing Address - Fax:
Practice Address - Street 1:1758 FRONT ST
Practice Address - Street 2:#106
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1261
Practice Address - Country:US
Practice Address - Phone:360-354-1226
Practice Address - Fax:360-354-6561
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist