Provider Demographics
NPI:1790214591
Name:HAUBENREISER, KESSY ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KESSY
Middle Name:ANN
Last Name:HAUBENREISER
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 1:17117 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3307
Mailing Address - Country:US
Mailing Address - Phone:708-532-7477
Mailing Address - Fax:
Practice Address - Street 1:17117 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3307
Practice Address - Country:US
Practice Address - Phone:708-532-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049214234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist