Provider Demographics
NPI:1598175036
Name:ABIDE, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ABIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 N TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4922
Mailing Address - Country:US
Mailing Address - Phone:817-431-4998
Mailing Address - Fax:
Practice Address - Street 1:15453 WOLF XING
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76247-7734
Practice Address - Country:US
Practice Address - Phone:903-439-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2021-08-23
Deactivation Date:2021-03-20
Deactivation Code:
Reactivation Date:2021-08-19
Provider Licenses
StateLicense IDTaxonomies
TX32779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist