Provider Demographics
NPI:1407589963
Name:PIDDINGTON, KATELYN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:
Last Name:PIDDINGTON
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 1:1705 US HIGHWAY 51 AND 138
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1907
Mailing Address - Country:US
Mailing Address - Phone:608-873-7612
Mailing Address - Fax:
Practice Address - Street 1:1705 US HIGHWAY 51 AND 138
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1907
Practice Address - Country:US
Practice Address - Phone:608-873-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21310-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist