Provider Demographics
NPI:1780374868
Name:BARRETT, KATELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N RENGSTORFF AVE APT 126
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4240
Mailing Address - Country:US
Mailing Address - Phone:775-229-5067
Mailing Address - Fax:
Practice Address - Street 1:300 PULLMAN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-9756
Practice Address - Country:US
Practice Address - Phone:925-243-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87967183500000X
COPHA.00228021835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy