Provider Demographics
NPI:1760032403
Name:DODGE, KATHERINE FRANCES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:FRANCES
Last Name:DODGE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 STATE ROUTE 91
Mailing Address - Street 2:
Mailing Address - City:FABIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13063-9712
Mailing Address - Country:US
Mailing Address - Phone:315-396-7006
Mailing Address - Fax:
Practice Address - Street 1:216 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3208
Practice Address - Country:US
Practice Address - Phone:315-703-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist