Provider Demographics
NPI:1215634191
Name:TOWNE, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:TOWNE
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 1:6916 HARLEQUIN CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9162
Mailing Address - Country:US
Mailing Address - Phone:765-635-7638
Mailing Address - Fax:
Practice Address - Street 1:601 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURUBUSCO
Practice Address - State:IN
Practice Address - Zip Code:46723-2203
Practice Address - Country:US
Practice Address - Phone:260-693-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022204A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist