Provider Demographics
NPI:1790074664
Name:PONDER, MARY KATHRYN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARY KATHRYN
Middle Name:
Last Name:PONDER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:PONDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1015A WEST GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-497-4936
Mailing Address - Fax:
Practice Address - Street 1:123 NORTHCREEK BLVD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1998
Practice Address - Country:US
Practice Address - Phone:615-859-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000023923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist