Provider Demographics
NPI:1902401904
Name:FOX, KATHERINE AMANDA
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMANDA
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8885
Mailing Address - Country:US
Mailing Address - Phone:609-268-0279
Mailing Address - Fax:609-268-0694
Practice Address - Street 1:1497 ROUTE 206
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-8885
Practice Address - Country:US
Practice Address - Phone:609-268-0279
Practice Address - Fax:609-268-0694
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03584800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist