Provider Demographics
NPI:1811205867
Name:DAVIS, KATHRYN LODEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LODEN
Last Name:DAVIS
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 1:809 VARSITY DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4615
Mailing Address - Country:US
Mailing Address - Phone:662-841-1983
Mailing Address - Fax:
Practice Address - Street 1:809 VARSITY DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4615
Practice Address - Country:US
Practice Address - Phone:662-841-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist