Provider Demographics
NPI:1801499926
Name:SMITH, KATHERINE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:SMITH
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 1:116 FORD DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-8554
Mailing Address - Country:US
Mailing Address - Phone:706-594-3711
Mailing Address - Fax:
Practice Address - Street 1:1597 HOGANSVILLE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-1423
Practice Address - Country:US
Practice Address - Phone:706-242-4902
Practice Address - Fax:706-242-9211
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist