Provider Demographics
NPI:1164780003
Name:RICHARDSON, KATIE L (PHARMD, BCOP)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, BCOP
Mailing Address - Street 1:800 ROSE STREET H110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-412-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist