Provider Demographics
NPI:1972137495
Name:SENTKOWSKI, JAMIE JACLYN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:JACLYN
Last Name:SENTKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:JACLYN
Other - Last Name:RESTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:278 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1618
Mailing Address - Country:US
Mailing Address - Phone:262-242-3451
Mailing Address - Fax:
Practice Address - Street 1:278 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1618
Practice Address - Country:US
Practice Address - Phone:262-242-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18924-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist