Provider Demographics
NPI:1710368972
Name:KANATAS, MARY BETH (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:KANATAS
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 1:2774 WELSFORD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3323
Mailing Address - Country:US
Mailing Address - Phone:614-486-7912
Mailing Address - Fax:
Practice Address - Street 1:2774 WELSFORD RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-3323
Practice Address - Country:US
Practice Address - Phone:614-486-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist