Basic Information
| Provider Information | |||||||||
| NPI: | 1700867439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOMPERDA | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 W 79TH ST | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604591554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084991545 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4901 W 79TH ST | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604591554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084991545 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 051-289965 | IL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.