Provider Demographics
NPI:1730521725
Name:HARBOUR, KATHLEEN A (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:HARBOUR
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 1:170 DAHOON CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0249
Mailing Address - Country:US
Mailing Address - Phone:352-799-2641
Mailing Address - Fax:
Practice Address - Street 1:2240 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-3810
Practice Address - Country:US
Practice Address - Phone:352-666-4600
Practice Address - Fax:352-688-9445
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103688200Medicaid
FL1376564682OtherNPI