Provider Demographics
NPI:1295794097
Name:URBATCHKA, KATHLEEN SUSAN (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:URBATCHKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:S
Other - Last Name:URBATCHKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2001 PIMA DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5821
Mailing Address - Country:US
Mailing Address - Phone:307-672-9363
Mailing Address - Fax:
Practice Address - Street 1:1333 W. 5TH ST.
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-673-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist