Provider Demographics
NPI:1649777855
Name:FAWBUSH, KATHIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:LYNN
Last Name:FAWBUSH
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 1:810 CANDIES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:TN
Mailing Address - Zip Code:37353-5533
Mailing Address - Country:US
Mailing Address - Phone:502-542-0862
Mailing Address - Fax:
Practice Address - Street 1:9334 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4855
Practice Address - Country:US
Practice Address - Phone:423-332-9957
Practice Address - Fax:423-332-9611
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist