Provider Demographics
NPI:1508382698
Name:KUEHL, KATHERINE L (RPH BSPHARMCIST)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:KUEHL
Suffix:
Gender:F
Credentials:RPH BSPHARMCIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BASILEO DR APT 705
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4680
Mailing Address - Country:US
Mailing Address - Phone:702-461-1815
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS 1870 E HISTORIC HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:GALLIUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-722-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONEOtherIL, NV,NM PHAMACIST ACTIVE LICENSES