Provider Demographics
NPI:1912132168
Name:KIRCHHOFF, JO LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:LYNNE
Last Name:KIRCHHOFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S. MAIN STREETS
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097
Mailing Address - Country:US
Mailing Address - Phone:269-649-1476
Mailing Address - Fax:269-649-4898
Practice Address - Street 1:110 S. MAIN STREETS
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097
Practice Address - Country:US
Practice Address - Phone:269-649-1476
Practice Address - Fax:269-649-4898
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028040183500000X
IN260153061A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist