Provider Demographics
NPI:1083267355
Name:KENNEASTER, KATHRINE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:KENNEASTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HOUSE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3178
Mailing Address - Country:US
Mailing Address - Phone:307-637-1605
Mailing Address - Fax:
Practice Address - Street 1:2301 HOUSE AVE STE 301
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3178
Practice Address - Country:US
Practice Address - Phone:307-637-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034387781835P2201X
WY45071835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care