Healthcare Provider Details

I. General information

NPI: 1922419829
Provider Name (Legal Business Name): KATHRYN MOMARY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 MERCER UNIVERSITY DR DEPARTMENT OF PHARMACY PRACTICE, DUVALL 148
ATLANTA GA
30341-4115
US

IV. Provider business mailing address

3001 MERCER UNIVERSITY DR DEPARTMENT OF PHARMACY PRACTICE, DUVALL 148
ATLANTA GA
30341-4115
US

V. Phone/Fax

Practice location:
  • Phone: 678-547-6218
  • Fax: 678-547-6384
Mailing address:
  • Phone: 678-547-6218
  • Fax: 678-547-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH024115
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051289581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: