Provider Demographics
NPI:1568884963
Name:JEWISON, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:JEWISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5017
Mailing Address - Country:US
Mailing Address - Phone:608-819-1523
Mailing Address - Fax:
Practice Address - Street 1:6321 MCKEE RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5017
Practice Address - Country:US
Practice Address - Phone:608-819-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12877-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist