Provider Demographics
NPI:1295047264
Name:LEHAULT, KATHLEEN MARY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:LEHAULT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:BOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2605
Mailing Address - Country:US
Mailing Address - Phone:714-475-9458
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1109
Practice Address - Country:US
Practice Address - Phone:845-938-4114
Practice Address - Fax:845-938-1120
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63238183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist