Provider Demographics
NPI:1497354757
Name:KILBANE, GRACE M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:M
Last Name:KILBANE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 LAKE SHORE DR E
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-2421
Mailing Address - Country:US
Mailing Address - Phone:715-682-3660
Mailing Address - Fax:
Practice Address - Street 1:2500 LAKE SHORE DR E
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-2421
Practice Address - Country:US
Practice Address - Phone:715-682-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18715-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist