Provider Demographics
NPI:1174642417
Name:MARENCIK, KATHRYN MAGRUDER (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MAGRUDER
Last Name:MARENCIK
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 1:1804 STONEMILL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4689
Mailing Address - Country:US
Mailing Address - Phone:540-387-0784
Mailing Address - Fax:
Practice Address - Street 1:1804 STONEMILL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4689
Practice Address - Country:US
Practice Address - Phone:540-387-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist