Provider Demographics
NPI:1881940849
Name:OWEN, KATHLEEN M
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 STATE ROUTE 15 N
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-1222
Mailing Address - Country:US
Mailing Address - Phone:973-361-9646
Mailing Address - Fax:973-361-4589
Practice Address - Street 1:315 STATE ROUTE 15 N
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-1222
Practice Address - Country:US
Practice Address - Phone:973-361-9646
Practice Address - Fax:973-361-4589
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01840500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist