Provider Demographics
NPI:1720615040
Name:KUNZ, JENNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KUNZ
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 1:660 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9832
Mailing Address - Country:US
Mailing Address - Phone:608-834-5601
Mailing Address - Fax:
Practice Address - Street 1:660 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9832
Practice Address - Country:US
Practice Address - Phone:608-834-5601
Practice Address - Fax:608-834-5611
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300519183500000X
WI18971-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist