Provider Demographics
NPI:1831832260
Name:LIEBERMAN, KATHLEEN KELLY (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KELLY
Last Name:LIEBERMAN
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 1:15568 WEST LASALLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5548
Mailing Address - Country:US
Mailing Address - Phone:303-807-3197
Mailing Address - Fax:
Practice Address - Street 1:2697 W BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-7148
Practice Address - Country:US
Practice Address - Phone:720-214-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist