Healthcare Provider Details

I. General information

NPI: 1508382698
Provider Name (Legal Business Name): KATHERINE L KUEHL RPH B.S.PHARMCIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALGREENS 1870 E HISTORIC HIGHWAY 66
GALLIUP NM
87301
US

IV. Provider business mailing address

350 BASILEO DR APT 705
GALLUP NM
87301-4680
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9499
  • Fax:
Mailing address:
  • Phone: 702-461-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008734
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: