Provider Demographics
NPI:1164825345
Name:SAUCY, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SAUCY
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 1:5250 COMMERCIAL ST SE
Mailing Address - Street 2:PHARMACY
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1018
Mailing Address - Country:US
Mailing Address - Phone:503-378-1822
Mailing Address - Fax:503-391-2714
Practice Address - Street 1:5250 COMMERCIAL ST SE
Practice Address - Street 2:PHARMACY
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1018
Practice Address - Country:US
Practice Address - Phone:503-378-1822
Practice Address - Fax:503-391-2714
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist