Provider Demographics
NPI:1205467628
Name:KOHLMANN, JORDYN CATHERINE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JORDYN
Middle Name:CATHERINE
Last Name:KOHLMANN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:CATHERINE
Other - Last Name:VANDENPLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 SERVICE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042
Mailing Address - Country:US
Mailing Address - Phone:920-894-4370
Mailing Address - Fax:920-894-7988
Practice Address - Street 1:1001 SERVICE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042
Practice Address - Country:US
Practice Address - Phone:920-894-4370
Practice Address - Fax:920-894-7988
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18936-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist