Provider Demographics
NPI:1578692000
Name:KONRARDY, GRETCHEN LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:LYNN
Last Name:KONRARDY
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 1:139 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1640
Mailing Address - Country:US
Mailing Address - Phone:608-723-4737
Mailing Address - Fax:608-723-4735
Practice Address - Street 1:139 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-1640
Practice Address - Country:US
Practice Address - Phone:608-723-4737
Practice Address - Fax:608-723-4735
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295474183500000X
WI16623-40183500000X
IA19813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014530Medicaid