Jacob Henricksen, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

20472-40 Issued in WI

Practice address

3726 22ND Ave
Kenosha, WI 53140-5300

Phone

(262) 654-6545

NPI assigned

Nov 30, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisconsin CVS Pharmacy LLC

  • Pharmacy
  • Kenosha, WI
  • NPI 1174564041
  NPD (past)
• Wisconsin CVS Pharmacy LLC

  • Pharmacy
  • Glendale, WI
  • NPI 1649947573
  NPD (past)

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1265037188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11221 SYNERGY DR APT 366",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532221351",
            "telephone_number": "763-202-9618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3726 22ND AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405300",
            "telephone_number": "262-654-6545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRICKSEN",
        "first_name": "JACOB",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "20472-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Rose Heine, MS
• Mary Kae Heller, LCSW
• William Todd Hendrick, D.C.
• Anders Hendricks, DPT, ATC
• Chloe Sophia Henn
• Brittney L Henry
• Miracle Hermann
• Catherine A Hernandez, PA-C
• Tamika Herron, PHARMD
• Herslof'S, Inc

• Pharmacist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Pharmacist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.