Provider Demographics
NPI:1821526815
Name:SMITH, KATHRYN ELAINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELAINE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2101 US 131
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-8821
Mailing Address - Country:US
Mailing Address - Phone:231-258-9116
Mailing Address - Fax:
Practice Address - Street 1:2377 E M 113
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9370
Practice Address - Country:US
Practice Address - Phone:231-263-5123
Practice Address - Fax:231-263-5513
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist