Provider Demographics
NPI:1215745799
Name:SMITH, KATHRYN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SMITH
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:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-0089
Mailing Address - Country:US
Mailing Address - Phone:417-845-7799
Mailing Address - Fax:
Practice Address - Street 1:704 S HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-8486
Practice Address - Country:US
Practice Address - Phone:417-845-7799
Practice Address - Fax:417-845-7797
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023029194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist