Provider Demographics
NPI:1285057422
Name:WUBBENHORST, KATHLEEN MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:WUBBENHORST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 S BRYN MAWR AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-3632
Mailing Address - Fax:484-337-3680
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-3632
Practice Address - Fax:484-337-3680
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARP442760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist