Basic Information
Provider Information
NPI: 1033559489
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REYNOLDS
FirstName: KATHRYN
MiddleName: C
NamePrefix: MRS.
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 12TH AVE S
Address2:  
City: NAMPA
State: ID
PostalCode: 836514255
CountryCode: US
TelephoneNumber: 2084671560
FaxNumber: 2084671823
Practice Location
Address1: 700 12TH AVE S
Address2:  
City: NAMPA
State: ID
PostalCode: 836514255
CountryCode: US
TelephoneNumber: 2084671560
FaxNumber: 2084671823
Other Information
ProviderEnumerationDate: 06/30/2013
LastUpdateDate: 06/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XP6810IDY Pharmacy Service ProvidersPharmacist 

No ID Information.


Home