Provider Demographics
NPI:1114162054
Name:LUEDTKE, PATRICIA (RPH)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:LUEDTKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 STATE ROAD 91 STE B
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-9218
Mailing Address - Country:US
Mailing Address - Phone:844-476-2781
Mailing Address - Fax:
Practice Address - Street 1:4041 STATE ROAD 91 STE B
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-9218
Practice Address - Country:US
Practice Address - Phone:844-476-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11657-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist