Provider Demographics
NPI:1477863637
Name:GRALL, KATHLEEN MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:GRALL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:SHOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:9175 ARGENTINE PASS TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7018
Mailing Address - Country:US
Mailing Address - Phone:719-393-2251
Mailing Address - Fax:
Practice Address - Street 1:5050 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8602
Practice Address - Country:US
Practice Address - Phone:719-264-5019
Practice Address - Fax:719-264-5016
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16162-PHA183500000X
COPHA0016162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist