Provider Demographics
NPI:1992911853
Name:KOEHLER, JERRY P (RPH)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:P
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 KENDALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-8608
Mailing Address - Country:US
Mailing Address - Phone:360-988-5101
Mailing Address - Fax:
Practice Address - Street 1:1758 FRONT ST
Practice Address - Street 2:#106
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1261
Practice Address - Country:US
Practice Address - Phone:360-354-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist