Provider Demographics
NPI:1508483546
Name:FETTERLY, CATHERINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:FETTERLY
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 1:958 HAILEY LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-4438
Mailing Address - Country:US
Mailing Address - Phone:710-404-0081
Mailing Address - Fax:
Practice Address - Street 1:958 HAILEY LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-4438
Practice Address - Country:US
Practice Address - Phone:710-404-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty