Provider Demographics
NPI:1255979910
Name:GARDNER, KATIE LYNN (CPHT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3840
Mailing Address - Country:US
Mailing Address - Phone:740-506-6260
Mailing Address - Fax:
Practice Address - Street 1:840 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3840
Practice Address - Country:US
Practice Address - Phone:740-506-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician