Provider Demographics
NPI:1144611575
Name:LUEDTKE, CARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:
Last Name:LUEDTKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5426
Mailing Address - Country:US
Mailing Address - Phone:920-682-3051
Mailing Address - Fax:920-682-4485
Practice Address - Street 1:919 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4504
Practice Address - Country:US
Practice Address - Phone:920-684-6789
Practice Address - Fax:920-684-7041
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14574-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist