Jennifer Mae Koen, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

42976 Issued in SD

Practice address

2410 Charleston Hwy
Cayce, SC 29033-1736

Phone

(803) 796-2586

NPI assigned

Jul 9, 2021

Last updated

Jul 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Mae Wagner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1215509252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 JOHN CHAPMAN RD",
            "city": "IRMO",
            "state": "SC",
            "postal_code": "290639044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 CHARLESTON HWY",
            "city": "CAYCE",
            "state": "SC",
            "postal_code": "290331736",
            "telephone_number": "803-796-2586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEN",
        "first_name": "JENNIFER",
        "middle_name": "MAE",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SD",
            "license": "42976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WAGNER",
            "middle_name": "MAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert Karpe, LPC
• Belinda Ann King, PMHNP-BC
• Julianne Stuck Kleckley, OD
• Derek Knight
• Zachary Austin Knox, PT, DPT
• Rachel Alexandra Kuntz, DPT
• Jean Ann Lambert, MA
• Bernard Leroy Langston IV, P.S.S
• Erin Marie Laughter, LMSW
• LB Medical Supply and Equipment LLC

• Pharmacist in Cayce, SC
• Providers in Cayce, SC by specialty
• Pharmacist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; 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.