Provider Demographics
NPI:1982145751
Name:GAINOUS, KATIE HARVEY (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:HARVEY
Last Name:GAINOUS
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 1:13775 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5398
Mailing Address - Country:US
Mailing Address - Phone:229-228-6419
Mailing Address - Fax:
Practice Address - Street 1:13775 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5398
Practice Address - Country:US
Practice Address - Phone:229-228-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55791183500000X
GARPH029674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist