Provider Demographics
NPI:1083991459
Name:KITCH, DEBORAH ANN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:KITCH
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:N4066 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-8994
Mailing Address - Country:US
Mailing Address - Phone:715-928-0046
Mailing Address - Fax:
Practice Address - Street 1:108 W WALL ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-9811
Practice Address - Country:US
Practice Address - Phone:715-479-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20090183500000X
WI14586-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist