Provider Demographics
NPI:1336882687
Name:ISON, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ISON
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 1:1416 ROCKWELL DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3839
Mailing Address - Country:US
Mailing Address - Phone:937-728-1702
Mailing Address - Fax:
Practice Address - Street 1:34 S ALLISON AVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3622
Practice Address - Country:US
Practice Address - Phone:937-372-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician