Provider Demographics
NPI:1427610070
Name:ADRIATICO, KATHRYN STEPHANIE BLANCO
Entity type:Individual
Prefix:
First Name:KATHRYN STEPHANIE
Middle Name:BLANCO
Last Name:ADRIATICO
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 1:701 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2829
Mailing Address - Country:US
Mailing Address - Phone:805-735-3343
Mailing Address - Fax:
Practice Address - Street 1:701 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2829
Practice Address - Country:US
Practice Address - Phone:805-735-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist