Healthcare Provider Details

I. General information

NPI: 1811181548
Provider Name (Legal Business Name): KASI LEE LUDWIG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1788 LILY OF THE VALLEY DR SUITE A
GREENVILLE WI
54942-9103
US

IV. Provider business mailing address

N1788 LILY OF THE VALLEY DR SUITE A
GREENVILLE WI
54942-9103
US

V. Phone/Fax

Practice location:
  • Phone: 920-757-3096
  • Fax: 920-757-3099
Mailing address:
  • Phone: 920-757-3096
  • Fax: 920-757-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: