Provider Demographics
NPI:1659991560
Name:LILIENTHAL, CATHERINE ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANNE
Last Name:LILIENTHAL
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 1:220 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1733
Mailing Address - Country:US
Mailing Address - Phone:563-927-3509
Mailing Address - Fax:563-927-8849
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1733
Practice Address - Country:US
Practice Address - Phone:563-927-3509
Practice Address - Fax:563-927-8849
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist