Provider Demographics
NPI:1225865843
Name:KOEPKE, OLIVIA JOLEEN-SAGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:JOLEEN-SAGE
Last Name:KOEPKE
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 1:532 HELENDALE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3116
Mailing Address - Country:US
Mailing Address - Phone:585-278-6474
Mailing Address - Fax:
Practice Address - Street 1:2157 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1793
Practice Address - Country:US
Practice Address - Phone:585-248-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist