Provider Demographics
NPI:1780828715
Name:KETCHUM, KATHY L (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:KETCHUM
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 1:500 SUMMER ST NE # E35
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1063
Mailing Address - Country:US
Mailing Address - Phone:503-947-5220
Mailing Address - Fax:
Practice Address - Street 1:500 SUMMER ST NE # E35
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1063
Practice Address - Country:US
Practice Address - Phone:503-947-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist