Provider Demographics
NPI:1871380394
Name:WAACK, KATHERINE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WAACK
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:WAACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1690 RIO VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6541
Mailing Address - Country:US
Mailing Address - Phone:913-216-4158
Mailing Address - Fax:
Practice Address - Street 1:1690 RIO VALLEY DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6541
Practice Address - Country:US
Practice Address - Phone:913-216-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA226211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist