Provider Demographics
NPI:1659601904
Name:STONE, KATHY JO (PHARM D / MT ASCP)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:JO
Last Name:STONE
Suffix:
Gender:F
Credentials:PHARM D / MT ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W ESPERANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2708
Mailing Address - Country:US
Mailing Address - Phone:520-648-2417
Mailing Address - Fax:520-625-5118
Practice Address - Street 1:313 W ESPERANZA BLVD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2708
Practice Address - Country:US
Practice Address - Phone:520-648-2417
Practice Address - Fax:520-625-5118
Is Sole Proprietor?:No
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist