Provider Demographics
NPI:1316192636
Name:AZMEH, KATHERINE NADIDA (RPH)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NADIDA
Last Name:AZMEH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:NADIDA
Other - Last Name:AZMEH-SCANLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633-0371
Mailing Address - Country:US
Mailing Address - Phone:907-723-6856
Mailing Address - Fax:
Practice Address - Street 1:3245 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-463-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist