Provider Demographics
NPI:1174804595
Name:PROBST, MARY KATHERINE SCHMOLL (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE SCHMOLL
Last Name:PROBST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:PROBST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5400 NEW CUT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4228
Mailing Address - Country:US
Mailing Address - Phone:502-599-2907
Mailing Address - Fax:
Practice Address - Street 1:5400 NEW CUT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4228
Practice Address - Country:US
Practice Address - Phone:502-599-2907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013666183500000X
IN26023133A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist