Provider Demographics
NPI:1720333164
Name:KRAAYENBRINK, EMMA (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KRAAYENBRINK
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 1:1690 ELM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3686
Mailing Address - Country:US
Mailing Address - Phone:563-239-9151
Mailing Address - Fax:563-235-2287
Practice Address - Street 1:1690 ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3686
Practice Address - Country:US
Practice Address - Phone:563-239-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist