Provider Demographics
NPI:1245216753
Name:BRAGG, KATHLEEN C (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:C
Last Name:BRAGG
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 1:2315 FALL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-5705
Mailing Address - Country:US
Mailing Address - Phone:817-860-2759
Mailing Address - Fax:
Practice Address - Street 1:2183 W GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5302
Practice Address - Country:US
Practice Address - Phone:817-451-5003
Practice Address - Fax:817-451-5393
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist