Jat Pharmacy, LLC

Primary specialty

Mail Order PharmacyTaxonomy code 3336M0002X

License

9015-42 Issued in WI

Legal business name

JAT PHARMACY, LLC

Practice address

805 Burton Boulevard
Suite a
Deforest, WI 53532

Phone

(877) 490-3577

Fax

(877) 490-3576

NPI assigned

Jun 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William A. Bartkowiak, R.PH., MBA

Title

Director of Pharmacy/Pharmacist in

Phone

(877) 490-3577

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• JAT Pharmacy, LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696550400000",
    "number": "1083935233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 BURTON BOULEVARD",
            "address_2": "SUITE A",
            "city": "DEFOREST",
            "state": "WI",
            "postal_code": "53532",
            "telephone_number": "877-490-3577",
            "fax_number": "877-490-3576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 BURTON BOULEVARD",
            "address_2": "SUITE A",
            "city": "DEFOREST",
            "state": "WI",
            "postal_code": "53532",
            "telephone_number": "877-490-3577",
            "fax_number": "877-490-3576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAT PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-22",
        "last_updated": "2023-10-06",
        "status": "A",
        "authorized_official_last_name": "BARTKOWIAK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY/PHARMACIST IN",
        "authorized_official_telephone_number": "877-490-3577",
        "authorized_official_credential": "R.PH., MBA"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": "WI",
            "license": "9015-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125332",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JAT Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JAT Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Hnilicka
• Amy L Hoffmann, LCSW
• Kelly Hofstetter
• Tracy Lytle Huffstatler, APN, RN, ACNP-BC
• Laura Jacques, MD
• Julie Christine Jones, RN
• Torina Ruth Kehoe, OTR/L
• Farah Khan, MD
• Daniel R Knuteson, RPH
• Carmen Krug, SLP

• All providers in Deforest, WI
• Mail Order Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.