Provider Demographics
NPI:1861572752
Name:KMOCH, JANA JO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:JO
Last Name:KMOCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-2739
Mailing Address - Country:US
Mailing Address - Phone:308-345-6359
Mailing Address - Fax:
Practice Address - Street 1:212 WESTVIEW PLZ
Practice Address - Street 2:NORTH HIGHWAY 83
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-4414
Practice Address - Country:US
Practice Address - Phone:308-345-5670
Practice Address - Fax:308-345-5676
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist