Provider Demographics
NPI:1427335876
Name:EGAN, CATHERINE E (RPH, PARMD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:EGAN
Suffix:
Gender:F
Credentials:RPH, PARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 W BELOIT RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4422
Mailing Address - Country:US
Mailing Address - Phone:414-328-1228
Mailing Address - Fax:414-328-1543
Practice Address - Street 1:9100 W BELOIT RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4422
Practice Address - Country:US
Practice Address - Phone:414-328-1228
Practice Address - Fax:414-328-1543
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13497040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33203800Medicaid
WI0282931697Medicare NSC