Provider Demographics
NPI:1396295846
Name:RACKOW, KAYLA (PHARMD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RACKOW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2371 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-9702
Mailing Address - Country:US
Mailing Address - Phone:608-214-6609
Mailing Address - Fax:
Practice Address - Street 1:405 W 8TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1063
Practice Address - Country:US
Practice Address - Phone:608-328-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18429-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist