Provider Demographics
NPI:1467057869
Name:BURDINE, KATHRYN THEISS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:THEISS
Last Name:BURDINE
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 1:199 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1211
Mailing Address - Country:US
Mailing Address - Phone:859-873-5451
Mailing Address - Fax:859-879-0495
Practice Address - Street 1:199 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1211
Practice Address - Country:US
Practice Address - Phone:859-873-5451
Practice Address - Fax:859-879-0495
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist