Provider Demographics
NPI:1245927839
Name:DOBNICK, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DOBNICK
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 1:1320 SINSKEY DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5999
Mailing Address - Country:US
Mailing Address - Phone:504-201-5674
Mailing Address - Fax:
Practice Address - Street 1:1320 SINSKEY DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-5999
Practice Address - Country:US
Practice Address - Phone:504-201-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPMP.029542-PST183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist