Provider Demographics
NPI:1972863843
Name:RAMOS, CATHLEEN V (PHARM D)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:V
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 STONE RUN LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7246
Mailing Address - Country:US
Mailing Address - Phone:208-528-8592
Mailing Address - Fax:
Practice Address - Street 1:1725 1ST ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4306
Practice Address - Country:US
Practice Address - Phone:208-419-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist