Provider Demographics
NPI:1124329644
Name:MAI, KATIE LINH (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LINH
Last Name:MAI
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 1:16 DENVER CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1504
Mailing Address - Country:US
Mailing Address - Phone:714-553-5821
Mailing Address - Fax:
Practice Address - Street 1:16 DENVER CT
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1504
Practice Address - Country:US
Practice Address - Phone:714-553-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI055169-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist