Provider Demographics
NPI:1013573088
Name:ST.GERMAIN, KELLIE MAUDE (RPHT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:MAUDE
Last Name:ST.GERMAIN
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N PATRICK
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446
Mailing Address - Country:US
Mailing Address - Phone:254-445-3679
Mailing Address - Fax:254-445-2771
Practice Address - Street 1:604 N PATRICK ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-1122
Practice Address - Country:US
Practice Address - Phone:254-445-3679
Practice Address - Fax:254-445-3679
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118184183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician