Provider Demographics
NPI:1306445838
Name:LIND, KATHLEEN MARY (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:LIND
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:N217 BARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-8769
Mailing Address - Country:US
Mailing Address - Phone:920-482-7161
Mailing Address - Fax:
Practice Address - Street 1:810 S IRISH RD
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1773
Practice Address - Country:US
Practice Address - Phone:920-849-7330
Practice Address - Fax:920-849-3145
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10968-401835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care