Provider Demographics
NPI:1235733502
Name:FELIU, KATHY JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:FELIU
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 1:4400 W STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-1051
Mailing Address - Country:US
Mailing Address - Phone:423-247-3176
Mailing Address - Fax:
Practice Address - Street 1:4400 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1051
Practice Address - Country:US
Practice Address - Phone:423-247-3176
Practice Address - Fax:423-247-0058
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004455183500000X
TN0000011429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist