Provider Demographics
NPI:1003218322
Name:LEADINGHAM, KATHERINE J (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:LEADINGHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:J
Other - Last Name:VASILAKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 N MYRTLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-1257
Mailing Address - Country:US
Mailing Address - Phone:704-864-6670
Mailing Address - Fax:704-864-6660
Practice Address - Street 1:223 N MYRTLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-1257
Practice Address - Country:US
Practice Address - Phone:704-864-6670
Practice Address - Fax:704-864-6660
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist