Provider Demographics
NPI:1841833068
Name:MORALES, KATIE YESENIA (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:YESENIA
Last Name:MORALES
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MINK RD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1212
Mailing Address - Country:US
Mailing Address - Phone:401-440-3949
Mailing Address - Fax:
Practice Address - Street 1:295 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4148
Practice Address - Country:US
Practice Address - Phone:401-273-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist