Provider Demographics
NPI:1639426034
Name:BLACKBURN, KATHERINE LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LEIGH
Last Name:BLACKBURN
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 1:101 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2322
Mailing Address - Country:US
Mailing Address - Phone:304-425-3024
Mailing Address - Fax:304-425-3268
Practice Address - Street 1:101 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2322
Practice Address - Country:US
Practice Address - Phone:304-425-3024
Practice Address - Fax:304-425-3268
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211597183500000X
WVRP0008015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist