Healthcare Provider Details

I. General information

NPI: 1700867439
Provider Name (Legal Business Name): KATHY ELIZABETH KOMPERDA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 W 79TH ST
BURBANK IL
60459-1554
US

IV. Provider business mailing address

4901 W 79TH ST
BURBANK IL
60459-1554
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-1545
  • Fax:
Mailing address:
  • Phone: 708-499-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-289965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: