Provider Demographics
NPI:1427806207
Name:WADE, KAYCIE LEIGH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAYCIE
Middle Name:LEIGH
Last Name:WADE
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 1:1796 N 75 E
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-7629
Mailing Address - Country:US
Mailing Address - Phone:812-486-5026
Mailing Address - Fax:
Practice Address - Street 1:10 WILLIAMS BROS DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4535
Practice Address - Country:US
Practice Address - Phone:812-254-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024163A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist