Provider Demographics
NPI:1063863165
Name:KRAFT, CATHERINE RUTH (PHARMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:RUTH
Last Name:KRAFT
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 1:23238 378TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382-6215
Mailing Address - Country:US
Mailing Address - Phone:712-209-1281
Mailing Address - Fax:
Practice Address - Street 1:901 S BURR ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4731
Practice Address - Country:US
Practice Address - Phone:605-996-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22860183500000X
SD6393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist