Provider Demographics
NPI:1659523280
Name:AZEVEDO, KATHLEEN JENNETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JENNETTE
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2739
Mailing Address - Country:US
Mailing Address - Phone:831-372-8085
Mailing Address - Fax:831-372-5768
Practice Address - Street 1:499 ALVARADO ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2739
Practice Address - Country:US
Practice Address - Phone:831-372-8085
Practice Address - Fax:831-372-5768
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist