Provider Demographics
NPI:1588949457
Name:SHOEMAKER, KATHLEEN A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5657 CREEKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167
Mailing Address - Country:US
Mailing Address - Phone:317-892-6261
Mailing Address - Fax:
Practice Address - Street 1:20 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112
Practice Address - Country:US
Practice Address - Phone:317-858-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019816A183500000X
IL5234464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26019816AOtherLICENSE