Provider Demographics
NPI:1598283277
Name:THOMAS, KATELYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:THOMAS
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 1:7913 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-0568
Mailing Address - Country:US
Mailing Address - Phone:337-540-2430
Mailing Address - Fax:
Practice Address - Street 1:2010 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5206
Practice Address - Country:US
Practice Address - Phone:337-990-4902
Practice Address - Fax:337-990-4904
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist