Provider Demographics
NPI:1528825791
Name:BERRYMAN, KATIE LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:BERRYMAN
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 1:437 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5421
Mailing Address - Country:US
Mailing Address - Phone:805-340-3256
Mailing Address - Fax:
Practice Address - Street 1:1317 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3342
Practice Address - Country:US
Practice Address - Phone:805-735-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist