Provider Demographics
NPI:1124580824
Name:HANLEY, KATIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E PALM VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3245
Mailing Address - Country:US
Mailing Address - Phone:512-255-2144
Mailing Address - Fax:512-255-2422
Practice Address - Street 1:701 E PALM VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3245
Practice Address - Country:US
Practice Address - Phone:512-255-2144
Practice Address - Fax:512-255-2422
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40966OtherPHARMACIST LICENSE