Provider Demographics
NPI:1720004492
Name:OKKEN, JILL M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:OKKEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 4TH AVE SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2445
Mailing Address - Country:US
Mailing Address - Phone:319-362-8976
Mailing Address - Fax:319-298-1669
Practice Address - Street 1:105 E 9TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2209
Practice Address - Country:US
Practice Address - Phone:319-467-2050
Practice Address - Fax:319-467-2070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist