Provider Demographics
NPI:1528384765
Name:HINES, KATHY GRUBER (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:GRUBER
Last Name:HINES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 KINGSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4628
Mailing Address - Country:US
Mailing Address - Phone:608-310-9922
Mailing Address - Fax:
Practice Address - Street 1:3250 KINGSLEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4628
Practice Address - Country:US
Practice Address - Phone:608-310-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13359-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist