Provider Demographics
NPI:1629374731
Name:LEOPOLD, KATHERINE LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LYNN
Other - Last Name:LEOPOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 26870
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80497-6870
Mailing Address - Country:US
Mailing Address - Phone:970-468-2311
Mailing Address - Fax:
Practice Address - Street 1:760 W JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2016
Practice Address - Country:US
Practice Address - Phone:920-929-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22499183500000X
CO18404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist