Healthcare Provider Details

I. General information

NPI: 1912905381
Provider Name (Legal Business Name): KINDRED PHARMACY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 S EMMER DR
NEW BERLIN WI
53151-7361
US

IV. Provider business mailing address

5055 S EMMER DR
NEW BERLIN WI
53151-7361
US

V. Phone/Fax

Practice location:
  • Phone: 262-641-0723
  • Fax: 262-641-0619
Mailing address:
  • Phone: 262-641-0723
  • Fax: 262-641-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8456042
License Number StateWI

VIII. Authorized Official

Name: MS. JILL SUSAN CZEBOTAR
Title or Position: MANAGER
Credential: RPH
Phone: 262-641-0723