Provider Demographics
NPI:1780272435
Name:SANSON, KATHRYN L (RPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:SANSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 N LOOP 340
Mailing Address - Street 2:
Mailing Address - City:LACY LAKEVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2470
Mailing Address - Country:US
Mailing Address - Phone:254-867-6700
Mailing Address - Fax:254-867-8441
Practice Address - Street 1:1207 N LOOP 340
Practice Address - Street 2:
Practice Address - City:LACY LAKEVIEW
Practice Address - State:TX
Practice Address - Zip Code:76705-2470
Practice Address - Country:US
Practice Address - Phone:254-867-6700
Practice Address - Fax:254-867-8441
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist