Provider Demographics
NPI:1356360978
Name:MCGINNIS, KATHRYN SUE (RPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MARK CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-9582
Mailing Address - Country:US
Mailing Address - Phone:541-679-6869
Mailing Address - Fax:
Practice Address - Street 1:142 MAIN ST.
Practice Address - Street 2:
Practice Address - City:RIDDLE
Practice Address - State:OR
Practice Address - Zip Code:97469
Practice Address - Country:US
Practice Address - Phone:541-874-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist