Provider Demographics
NPI:1619514882
Name:KATHAN, RENEE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:KATHAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:KATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20820 BLUEGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-8771
Mailing Address - Country:US
Mailing Address - Phone:903-312-8107
Mailing Address - Fax:
Practice Address - Street 1:3828 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1726
Practice Address - Country:US
Practice Address - Phone:903-281-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30164OtherTEXAS BOARD OF PHARMACY
317590OtherNABP