Provider Demographics
NPI:1679971576
Name:MEDVED, KATHERINE ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANN
Last Name:MEDVED
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 1:17295 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2004
Mailing Address - Country:US
Mailing Address - Phone:262-373-1080
Mailing Address - Fax:262-373-1083
Practice Address - Street 1:17295 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2004
Practice Address - Country:US
Practice Address - Phone:262-373-1080
Practice Address - Fax:262-373-1083
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI99881835P0018X
WI9988-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist