Provider Demographics
NPI:1508119322
Name:BERNARD, KATHRYN JILL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JILL
Last Name:BERNARD
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 1:260 SHIELD RD
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-7735
Mailing Address - Country:US
Mailing Address - Phone:337-257-7656
Mailing Address - Fax:
Practice Address - Street 1:410 CRESWELL LN
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5810
Practice Address - Country:US
Practice Address - Phone:337-942-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist