Provider Demographics
NPI:1801177951
Name:PADGETT, KATHLEEN CAMILLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CAMILLE
Last Name:PADGETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 LIGE BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7993
Mailing Address - Country:US
Mailing Address - Phone:904-287-3595
Mailing Address - Fax:904-230-9865
Practice Address - Street 1:390 STATE ROAD 13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-2837
Practice Address - Country:US
Practice Address - Phone:904-230-4696
Practice Address - Fax:904-230-4699
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0022500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist