Provider Demographics
NPI:1063669570
Name:WRENN, KATHLEEN M (RPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:WRENN
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 1:102 CASPIAN TERN CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-7134
Mailing Address - Country:US
Mailing Address - Phone:910-270-6041
Mailing Address - Fax:
Practice Address - Street 1:622 N MARINE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6142
Practice Address - Country:US
Practice Address - Phone:910-455-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist