Provider Demographics
NPI:1669740254
Name:SMYTHE, KATRINA MARTINEZ (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:MARTINEZ
Last Name:SMYTHE
Suffix:
Gender:F
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 1:28095 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2239
Mailing Address - Country:US
Mailing Address - Phone:601-894-5501
Mailing Address - Fax:601-894-5721
Practice Address - Street 1:28095 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2239
Practice Address - Country:US
Practice Address - Phone:601-894-5501
Practice Address - Fax:601-894-5721
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist