Provider Demographics
NPI:1194008839
Name:SMITH, KATHLEEN ANNE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:PROFIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6730 BLUFFTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-2649
Mailing Address - Country:US
Mailing Address - Phone:260-747-7563
Mailing Address - Fax:260-747-1909
Practice Address - Street 1:6730 BLUFFTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-2649
Practice Address - Country:US
Practice Address - Phone:260-747-7563
Practice Address - Fax:260-747-1909
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020803A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist