Provider Demographics
NPI:1124356308
Name:LUPERCIO, KATHRYN L (RPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:LUPERCIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:60 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5427
Mailing Address - Country:US
Mailing Address - Phone:541-461-1433
Mailing Address - Fax:541-461-1443
Practice Address - Street 1:60 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5427
Practice Address - Country:US
Practice Address - Phone:541-461-1433
Practice Address - Fax:541-467-1443
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR86861835P0018X
OR8686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist