Provider Demographics
NPI:1093039547
Name:SYKES, KATINA RENEA
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:RENEA
Last Name:SYKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8028
Mailing Address - Country:US
Mailing Address - Phone:931-216-2171
Mailing Address - Fax:931-551-8198
Practice Address - Street 1:1500 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3846
Practice Address - Country:US
Practice Address - Phone:931-552-2552
Practice Address - Fax:931-551-8198
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist