Provider Demographics
NPI:1710995485
Name:ADAIR, KATHLEEN JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:JANE
Last Name:ADAIR
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 1:106 WOODLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1754
Mailing Address - Country:US
Mailing Address - Phone:309-694-6551
Mailing Address - Fax:
Practice Address - Street 1:411 MARTIN LUTHER KING DR
Practice Address - Street 2:119P
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2400
Practice Address - Country:US
Practice Address - Phone:309-497-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist