Provider Demographics
NPI:1750591434
Name:PHILLIPS, KATHERINE LYNNE (PD)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LYNNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 BECKY BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9404
Mailing Address - Country:US
Mailing Address - Phone:479-967-8433
Mailing Address - Fax:479-964-9280
Practice Address - Street 1:1808 W MAIN ST
Practice Address - Street 2:PHARMACY
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2724
Practice Address - Country:US
Practice Address - Phone:479-964-9164
Practice Address - Fax:479-964-9280
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist