Healthcare Provider Details

I. General information

NPI: 1306445838
Provider Name (Legal Business Name): KATHLEEN MARY LIND RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S IRISH RD
CHILTON WI
53014-1773
US

IV. Provider business mailing address

N217 BARBERRY LN
APPLETON WI
54915-8769
US

V. Phone/Fax

Practice location:
  • Phone: 920-849-7330
  • Fax: 920-849-3145
Mailing address:
  • Phone: 920-482-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number10968-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: