Provider Demographics
NPI:1366789257
Name:TON, KATELYN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:TON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 S CAMROSE ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2401
Mailing Address - Country:US
Mailing Address - Phone:727-244-4647
Mailing Address - Fax:
Practice Address - Street 1:3825 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1936
Practice Address - Country:US
Practice Address - Phone:727-538-8718
Practice Address - Fax:727-538-8729
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37901183500000X
CA74536183500000X
TX6007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist