Provider Demographics
NPI:1215319132
Name:KROEGER, JEAN ROBERT III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ROBERT
Last Name:KROEGER
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 EGLIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-9504
Mailing Address - Country:US
Mailing Address - Phone:605-341-8621
Mailing Address - Fax:605-341-8631
Practice Address - Street 1:1415 EGLIN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-9504
Practice Address - Country:US
Practice Address - Phone:605-341-8621
Practice Address - Fax:605-341-8631
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist