Provider Demographics
NPI:1194156166
Name:REKOWSKI, KATHLEEN (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:REKOWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N65W24838 MAIN ST # 400
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2670
Mailing Address - Country:US
Mailing Address - Phone:262-820-0200
Mailing Address - Fax:262-820-0243
Practice Address - Street 1:N65W24838 MAIN ST # 400
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2670
Practice Address - Country:US
Practice Address - Phone:262-820-0200
Practice Address - Fax:262-820-0243
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5133804OtherNCPDP
WI1396185278OtherNPI