Provider Demographics
NPI:1972103786
Name:KALK, JAN RENEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:RENEE
Last Name:KALK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:RENEE
Other - Last Name:ECKERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:5868 W RILLA MAE RD
Mailing Address - Street 2:
Mailing Address - City:TASWELL
Mailing Address - State:IN
Mailing Address - Zip Code:47175-7123
Mailing Address - Country:US
Mailing Address - Phone:812-613-0629
Mailing Address - Fax:
Practice Address - Street 1:735 N GOSPEL ST
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-1419
Practice Address - Country:US
Practice Address - Phone:812-723-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017238A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist