Provider Demographics
NPI:1548546245
Name:DAMICO, KATHLEEN FARR
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FARR
Last Name:DAMICO
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 1:2311 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7221
Mailing Address - Country:US
Mailing Address - Phone:630-898-3431
Mailing Address - Fax:
Practice Address - Street 1:2311 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7221
Practice Address - Country:US
Practice Address - Phone:630-898-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031661183500000X
FL19114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist