Provider Demographics
NPI:1649556259
Name:KUNICKI, JILL MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:KUNICKI
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 1:7520 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1128
Mailing Address - Country:US
Mailing Address - Phone:262-857-9484
Mailing Address - Fax:262-857-2707
Practice Address - Street 1:7520 118TH AVE
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1128
Practice Address - Country:US
Practice Address - Phone:262-857-9484
Practice Address - Fax:262-857-2707
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14174-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist