Provider Demographics
NPI:1669743126
Name:LITTEN, KEVIN D
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:LITTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54727-9658
Mailing Address - Country:US
Mailing Address - Phone:715-289-3243
Mailing Address - Fax:715-289-3242
Practice Address - Street 1:973 N KELLY ST
Practice Address - Street 2:#10 C
Practice Address - City:CADOTT
Practice Address - State:WI
Practice Address - Zip Code:54727-9653
Practice Address - Country:US
Practice Address - Phone:319-361-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10481-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist