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General NPI Number Information
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NPI Number | 1275034407
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Entity Type | Individual
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Provider Name | KATHLEEN ROSE ANDERSON DPH
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 3200 FORT HENRY DR
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City | KINGSPORT
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State | TN
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Zip | 37664-4022
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Country | US
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Telephone | 423-392-9860
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Fax | 423-378-5892
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Provider Business Mailing Address
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Address Line | 1113 WIEMBLEY DR
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City | KINGSPORT
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State | TN
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Zip | 37664-5193
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Country | US
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Telephone | 423-863-7197
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0000009748
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License Number State | TN
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