Provider Demographics
NPI:1265431050
Name:KILPATRICK, AUDIE GWYN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AUDIE
Middle Name:GWYN
Last Name:KILPATRICK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 COUNTY ROAD 6920
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-5758
Mailing Address - Country:US
Mailing Address - Phone:806-725-0042
Mailing Address - Fax:806-793-8736
Practice Address - Street 1:8007 COUNTY ROAD 6920
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-5758
Practice Address - Country:US
Practice Address - Phone:806-725-0042
Practice Address - Fax:806-793-8736
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist