Provider Demographics
NPI:1295119048
Name:KREMZAR, KATLYN (RPH)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:KREMZAR
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 1:707 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8305
Mailing Address - Country:US
Mailing Address - Phone:262-497-5257
Mailing Address - Fax:
Practice Address - Street 1:707 EDWARD ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8305
Practice Address - Country:US
Practice Address - Phone:262-497-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17878-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist