Provider Demographics
NPI:1801915517
Name:THAUT, KATHERINE ALICIA (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ALICIA
Last Name:THAUT
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 1:917 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-3652
Mailing Address - Country:US
Mailing Address - Phone:515-963-0069
Mailing Address - Fax:
Practice Address - Street 1:7101 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1436
Practice Address - Country:US
Practice Address - Phone:515-279-9648
Practice Address - Fax:515-279-9691
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist