Provider Demographics
NPI:1134456098
Name:DEVIZIA, KATHRYN REBECCA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:REBECCA
Last Name:DEVIZIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3411
Mailing Address - Country:US
Mailing Address - Phone:919-872-5233
Mailing Address - Fax:
Practice Address - Street 1:3911 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3411
Practice Address - Country:US
Practice Address - Phone:919-872-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC361924025OtherTAX ID