Provider Demographics
NPI:1417239310
Name:AARDEMA, KATHRYN E (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:AARDEMA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:WHITVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:20002 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1320
Mailing Address - Country:US
Mailing Address - Phone:708-478-3244
Mailing Address - Fax:708-478-3286
Practice Address - Street 1:20002 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1320
Practice Address - Country:US
Practice Address - Phone:708-478-3244
Practice Address - Fax:708-478-3286
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist