Provider Demographics
NPI:1326602848
Name:HAMBUCHEN, KATIE CLARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:CLARK
Last Name:HAMBUCHEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WARRIOR WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6401
Mailing Address - Country:US
Mailing Address - Phone:970-208-0041
Mailing Address - Fax:
Practice Address - Street 1:541 WARRIOR WAY
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6401
Practice Address - Country:US
Practice Address - Phone:970-208-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist