Provider Demographics
NPI:1952569899
Name:KOEHLER, JESSE DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:DAVID
Last Name:KOEHLER
Suffix:
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 1:1786-I COLUMBIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-9508
Mailing Address - Country:US
Mailing Address - Phone:717-684-0025
Mailing Address - Fax:717-684-2842
Practice Address - Street 1:1786 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9508
Practice Address - Country:US
Practice Address - Phone:717-684-0025
Practice Address - Fax:717-684-2842
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist