MEDICARE: MRS. CATHY T KING CLARETT RPH

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	183500000X	Pharmacist	26013807A	IN

General Provider Information

NPI Number	:	1952594665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHY T KING CLARETT RPH

Provider Business Mailing Address
First Line	:	11061 DEER CREEK DR
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-7141
Country	:	US
Telephone Number	:	219-663-2380
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 S LAKE ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403-2918
Country	:	US
Telephone Number	:	219-938-4857
Fax Number	:

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

Provider Enumeration Date	:	08/26/2007
Last Update Date	:	08/26/2007

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