Provider Demographics
NPI:1710262696
Name:VENNERI, KATIE ELLEN
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELLEN
Last Name:VENNERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE CIRCLE WAY APT 521
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6133
Mailing Address - Country:US
Mailing Address - Phone:724-322-1802
Mailing Address - Fax:
Practice Address - Street 1:5311 N ROXBORO RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-2227
Practice Address - Country:US
Practice Address - Phone:919-471-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist