Provider Demographics
NPI:1679857866
Name:KOCHANNY, JANA FRANCES (RPH)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:FRANCES
Last Name:KOCHANNY
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 1:23297 MACKINAW TRL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49688-8307
Mailing Address - Country:US
Mailing Address - Phone:231-775-6383
Mailing Address - Fax:231-775-6543
Practice Address - Street 1:602 S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2510
Practice Address - Country:US
Practice Address - Phone:231-775-6383
Practice Address - Fax:231-775-6546
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist