Provider Demographics
NPI:1447877501
Name:PROCUPP, KATHIE JEAN (RPH)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:JEAN
Last Name:PROCUPP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ROUPE RD
Mailing Address - Street 2:
Mailing Address - City:EIGHTY FOUR
Mailing Address - State:PA
Mailing Address - Zip Code:15330-2481
Mailing Address - Country:US
Mailing Address - Phone:412-726-6302
Mailing Address - Fax:
Practice Address - Street 1:1001 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-1502
Practice Address - Country:US
Practice Address - Phone:412-733-1953
Practice Address - Fax:412-920-2867
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044173L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP044173LOtherSTATE ISSUED LICENSE