Provider Demographics
NPI:1902427099
Name:TIERNEY, KATHERINE BELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BELLE
Last Name:TIERNEY
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 1:611 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1462
Mailing Address - Country:US
Mailing Address - Phone:515-332-5082
Mailing Address - Fax:
Practice Address - Street 1:611 10TH AVE N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1462
Practice Address - Country:US
Practice Address - Phone:515-332-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist