MEDICARE: KATHERINE L PERRY CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	PT00010877	KY

General Provider Information

NPI Number	:	1275923823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE L PERRY CPHT

Provider Business Mailing Address
First Line	:	7311 JEFFERSON BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-6178
Country	:	US
Telephone Number	:	502-968-9256
Fax Number	:	502-653-6759

Provider Business Practice Location Address
First Line	:	7311 JEFFERSON BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-6178
Country	:	US
Telephone Number	:	502-968-9256
Fax Number	:	502-653-6759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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