Provider Demographics
NPI:1952935017
Name:REIKOWSKI, KYLIE SLAATS
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:SLAATS
Last Name:REIKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-1616
Mailing Address - Country:US
Mailing Address - Phone:608-781-0791
Mailing Address - Fax:608-781-0846
Practice Address - Street 1:2626 ROSE ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-1616
Practice Address - Country:US
Practice Address - Phone:608-781-0791
Practice Address - Fax:608-781-0846
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20111-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist