Provider Demographics
NPI:1720420102
Name:CLUDERAY, KATHRYN RANDOLPH (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RANDOLPH
Last Name:CLUDERAY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BRAWLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9121
Mailing Address - Country:US
Mailing Address - Phone:704-662-8856
Mailing Address - Fax:704-662-8710
Practice Address - Street 1:614 BRAWLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9121
Practice Address - Country:US
Practice Address - Phone:704-662-8856
Practice Address - Fax:704-662-8710
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist