Provider Demographics
NPI:1689789075
Name:JANKOWSKI, JOHN RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:JANKOWSKI
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:N54W6135 MILL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2021
Mailing Address - Country:US
Mailing Address - Phone:262-375-0010
Mailing Address - Fax:262-375-0080
Practice Address - Street 1:N54W6135 MILL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2021
Practice Address - Country:US
Practice Address - Phone:262-375-0010
Practice Address - Fax:262-375-0080
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist