Provider Demographics
NPI:1235000365
Name:KOEBERL, COURTNEY ROSE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROSE
Last Name:KOEBERL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPRINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2067
Mailing Address - Country:US
Mailing Address - Phone:608-437-9160
Mailing Address - Fax:
Practice Address - Street 1:1401 SPRINGDALE ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-2067
Practice Address - Country:US
Practice Address - Phone:608-437-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23222-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist