Provider Demographics
NPI:1669521167
Name:KATTERJOHN, RPH, KYLE PITMAN (RPH)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:PITMAN
Last Name:KATTERJOHN, RPH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-2080
Mailing Address - Country:US
Mailing Address - Phone:270-442-2990
Mailing Address - Fax:270-443-1597
Practice Address - Street 1:1100 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-2080
Practice Address - Country:US
Practice Address - Phone:270-442-2990
Practice Address - Fax:270-443-1597
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP00696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4554642100Medicaid
KY0918150001Medicare NSC