Provider Demographics
NPI:1629677810
Name:LAUER, KRISTIN ANGELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANGELA
Last Name:LAUER
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:W8895 HACKETT LN
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-9504
Mailing Address - Country:US
Mailing Address - Phone:920-470-7741
Mailing Address - Fax:
Practice Address - Street 1:1155 W WINNECONNE AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3693
Practice Address - Country:US
Practice Address - Phone:920-722-1185
Practice Address - Fax:920-722-1446
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14541-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist