=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861716235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHI-ANNE VANHINE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2010
-----------------------------------------------------
Last Update Date | 03/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 AZALEA DR
-----------------------------------------------------
City | APALACHIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13732-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-625-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 AZALEA DRIVE
-----------------------------------------------------
City | APALACHIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-625-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 565578
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------