Provider Demographics
NPI:1295092211
Name:KYBURZ, ELIZABETH JANE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JANE
Last Name:KYBURZ
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 1:2233 OLD HUMES RD
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0258
Mailing Address - Country:US
Mailing Address - Phone:608-754-1299
Mailing Address - Fax:608-754-7807
Practice Address - Street 1:2233 OLD HUMES RD
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0258
Practice Address - Country:US
Practice Address - Phone:608-754-1299
Practice Address - Fax:608-754-7807
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16498-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist