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General NPI Number Information
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NPI Number | 1912905381
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Entity Type | Organization
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Legal Business Name | KINDRED PHARMACY SERVICES
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5055 S EMMER DR
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City | NEW BERLIN
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State | WI
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Zip | 53151-7361
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Country | US
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Telephone | 262-641-0723
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Fax | 262-641-0619
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Provider Business Mailing Address
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Address Line | 5055 S EMMER DR
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City | NEW BERLIN
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State | WI
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Zip | 53151-7361
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Country | US
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Telephone | 262-641-0723
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Fax | 262-641-0619
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JILL SUSAN CZEBOTAR
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Credential | RPH
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Telephone | 262-641-0723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 8456042
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License Number State | WI
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