Provider Demographics
NPI:1396024634
Name:FIDDIE, KATHLEEN LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LEE
Last Name:FIDDIE
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 1:2607 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4803
Mailing Address - Country:US
Mailing Address - Phone:864-288-0136
Mailing Address - Fax:864-288-9275
Practice Address - Street 1:2607 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4803
Practice Address - Country:US
Practice Address - Phone:864-288-0136
Practice Address - Fax:864-288-9275
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6836183500000X
SC10474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist