Provider Demographics
NPI:1699215061
Name:MIRES, KATIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:MIRES
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 1:560 FIELD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8338
Mailing Address - Country:US
Mailing Address - Phone:605-348-0815
Mailing Address - Fax:
Practice Address - Street 1:3615 5TH ST
Practice Address - Street 2:STE 109
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6014
Practice Address - Country:US
Practice Address - Phone:605-348-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5559183500000X
NE13496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist