MEDICARE: DR. KATHY ELIZABETH KOMPERDA PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051-289965	IL

General Provider Information

NPI Number	:	1700867439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY ELIZABETH KOMPERDA PHARM.D.

Provider Business Mailing Address
First Line	:	4901 W 79TH ST
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-499-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 W 79TH ST
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1554
Country	:	US
Telephone Number	:	708-499-1545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	10/18/2018

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