Jon Charles Oconnell, RPH
Individual provider Active NPI Pharmacist · Jackson, WI
NPI 1598033524 · NPPES record last updated Dec 5, 2011
Key facts
- NPI
- 1598033524
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- R-9149 (WI)
- Practice address
- N168 W21330 Main Street
Jackson, WI 53051 - Phone
- (262) 677-1702
- Fax
- (262) 677-2524
- NPI assigned
- Dec 5, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-9149 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | R-9149 | WI | Yes |
Addresses
Primary practice location
N168 W21330 Main Street
Jackson, WI 53051
Mailing address
N168W21330 Main St
Jackson, WI 53037-9636
Phone (262) 677-1702
Other providers in Jackson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.