Provider Demographics
NPI:1679505010
Name:THOM, KATHERINE P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:P
Last Name:THOM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:P
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1387 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2555
Mailing Address - Country:US
Mailing Address - Phone:702-283-2136
Mailing Address - Fax:
Practice Address - Street 1:10920 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3538
Practice Address - Country:US
Practice Address - Phone:801-878-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV151231835P1200X
UT7338576-17011835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy