Provider Demographics
NPI:1265078893
Name:BONNET THAIN, KATHRYN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BONNET THAIN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 BUCKFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-7523
Mailing Address - Country:US
Mailing Address - Phone:260-403-5975
Mailing Address - Fax:
Practice Address - Street 1:4120 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1230
Practice Address - Country:US
Practice Address - Phone:260-483-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016303A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist