Provider Demographics
NPI:1013294370
Name:KAUFMANN, ANN MAIRE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MAIRE
Last Name:KAUFMANN
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 1:56 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HEATH
Mailing Address - State:IL
Mailing Address - Zip Code:61884-9740
Mailing Address - Country:US
Mailing Address - Phone:217-687-4902
Mailing Address - Fax:
Practice Address - Street 1:56 GLENN DR
Practice Address - Street 2:
Practice Address - City:WHITE HEATH
Practice Address - State:IL
Practice Address - Zip Code:61884-9740
Practice Address - Country:US
Practice Address - Phone:217-687-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.038260183500000X
FLPS0029511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist