Healthcare Provider Details

I. General information

NPI: 1417876913
Provider Name (Legal Business Name): KATHRYN LEE COUNTRYMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PFINGSTEN RD
GLENVIEW IL
60026-1361
US

IV. Provider business mailing address

1224 INVERRARY LN
DEERFIELD IL
60015-3612
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-6864
  • Fax:
Mailing address:
  • Phone: 630-240-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308874
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: