Provider Demographics
NPI:1952594665
Name:KING CLARETT, CATHY T (RPH)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:T
Last Name:KING CLARETT
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 1:11061 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7141
Mailing Address - Country:US
Mailing Address - Phone:219-663-2380
Mailing Address - Fax:
Practice Address - Street 1:825 S LAKE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2918
Practice Address - Country:US
Practice Address - Phone:219-938-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013807A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist