Provider Demographics
NPI:1992006308
Name:KINCHEN, JEANIE (R PH)
Entity Type:Individual
Prefix:MRS
First Name:JEANIE
Middle Name:
Last Name:KINCHEN
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N SANTA CLAUS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6081
Mailing Address - Country:US
Mailing Address - Phone:907-490-2760
Mailing Address - Fax:907-490-2719
Practice Address - Street 1:301 N SANTA CLAUS LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-6081
Practice Address - Country:US
Practice Address - Phone:907-490-2760
Practice Address - Fax:907-490-2719
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist