Provider Demographics
NPI:1841894714
Name:KROUSE, PATRICIA C (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:KROUSE
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 1:16030 DONNA MARIE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6954
Mailing Address - Country:US
Mailing Address - Phone:708-280-5745
Mailing Address - Fax:
Practice Address - Street 1:16030 DONNA MARIE DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6954
Practice Address - Country:US
Practice Address - Phone:082-805-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014335A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist