Provider Demographics
NPI:1316904741
Name:KATA, JEFFERY TODD (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:TODD
Last Name:KATA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:TODD
Other - Last Name:KATA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3310 BELL WICK RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425
Mailing Address - Country:US
Mailing Address - Phone:330-534-8463
Mailing Address - Fax:
Practice Address - Street 1:2603 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509
Practice Address - Country:US
Practice Address - Phone:330-799-9737
Practice Address - Fax:330-799-5509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist