Provider Demographics
NPI:1104033828
Name:KUKER, AMY CATHLEEN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:CATHLEEN
Last Name:KUKER
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-0215
Mailing Address - Country:US
Mailing Address - Phone:608-798-3031
Mailing Address - Fax:
Practice Address - Street 1:1910 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528-9594
Practice Address - Country:US
Practice Address - Phone:608-798-3031
Practice Address - Fax:608-798-3932
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14106-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist