Provider Demographics
NPI:1306060843
Name:GRAUE, KATHERINE JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JEAN
Last Name:GRAUE
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 1:7409 PIPER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7092
Mailing Address - Country:US
Mailing Address - Phone:217-391-3823
Mailing Address - Fax:
Practice Address - Street 1:1050 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1078
Practice Address - Country:US
Practice Address - Phone:217-483-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist