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NPI Code Detail

MEDICARE: KATIE WIDUP PHARMD

MEDICARE: KATIE WIDUP PHARMD
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
1183500000XPharmacist26027192AIN

General Provider Information

NPI Number : 1811512726
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE WIDUP PHARMD
Provider Business Mailing Address
First Line : 1010 E IRELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-2665
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1010 E IRELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-2665
Country : US
Telephone Number : 574-299-0154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2020
Last Update Date : 06/16/2020

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Directions to “ KATIE WIDUP PHARMD” Practice Location

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