Provider Demographics
NPI:1508209131
Name:NIELSEN, KATHERINE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:KEESLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:501 S LINCOLN AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5945
Mailing Address - Country:US
Mailing Address - Phone:727-479-3048
Mailing Address - Fax:727-479-3047
Practice Address - Street 1:501 S LINCOLN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5945
Practice Address - Country:US
Practice Address - Phone:727-479-3048
Practice Address - Fax:727-479-3047
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22116OtherSTATE LICENSE