Provider Demographics
NPI:1447000310
Name:BOSSE, KATHLEEN DANIELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:DANIELLE
Last Name:BOSSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 UNIVERSITY AVE NE APT 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1939
Mailing Address - Country:US
Mailing Address - Phone:608-438-8121
Mailing Address - Fax:
Practice Address - Street 1:3121 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2028
Practice Address - Country:US
Practice Address - Phone:612-721-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist