Provider Demographics
NPI:1235745175
Name:KRAFT, REBECCA (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
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 1:2721 N 2100 EAST RD
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUND
Mailing Address - State:IL
Mailing Address - Zip Code:62513-8655
Mailing Address - Country:US
Mailing Address - Phone:618-531-0679
Mailing Address - Fax:
Practice Address - Street 1:2721 N 2100 EAST RD
Practice Address - Street 2:
Practice Address - City:BLUE MOUND
Practice Address - State:IL
Practice Address - Zip Code:62513-8655
Practice Address - Country:US
Practice Address - Phone:618-531-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294876183500000X
MO2002027593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist