Provider Demographics
NPI:1740574482
Name:WYNNE, KATHERINE SCHMIDT
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SCHMIDT
Last Name:WYNNE
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 1:612 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-9719
Mailing Address - Country:US
Mailing Address - Phone:919-528-4709
Mailing Address - Fax:919-528-5170
Practice Address - Street 1:612 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9719
Practice Address - Country:US
Practice Address - Phone:919-528-4709
Practice Address - Fax:919-528-5170
Is Sole Proprietor?:No
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist