Provider Demographics
NPI:1093356719
Name:BARRY, KATHRYN (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BARRY
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 1:4611 JANET PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1909
Mailing Address - Country:US
Mailing Address - Phone:949-228-0765
Mailing Address - Fax:
Practice Address - Street 1:9610 RIDGEHAVEN CT STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5603
Practice Address - Country:US
Practice Address - Phone:619-543-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist