Provider Demographics
NPI:1861895534
Name:SMITH, KATHLEEN ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:BROMFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:243 S. PROSPECT ST.
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634
Mailing Address - Country:US
Mailing Address - Phone:570-735-2300
Mailing Address - Fax:570-258-2036
Practice Address - Street 1:243 S. PROSPECT ST.
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634
Practice Address - Country:US
Practice Address - Phone:570-735-2300
Practice Address - Fax:570-258-2036
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028889L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist