Provider Demographics
NPI:1396182564
Name:MASSENGILL, KATHLEEN LEIGH (PHARM D)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LEIGH
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8209
Mailing Address - Country:US
Mailing Address - Phone:901-757-5017
Mailing Address - Fax:901-757-1260
Practice Address - Street 1:2891 KIRBY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8209
Practice Address - Country:US
Practice Address - Phone:901-757-5017
Practice Address - Fax:901-757-1260
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist