MEDICARE: KAITLIN O'ROURKE PHARMD

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	1835P2201X	Ambulatory Care Pharmacist	PH233609	MA

General Provider Information

NPI Number	:	1083145080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN O'ROURKE PHARMD

Provider Business Mailing Address
First Line	:	301 S HUNTINGTON AVE
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4807
Country	:	US
Telephone Number	:	857-307-3365
Fax Number	:	857-307-3305

Provider Business Practice Location Address
First Line	:	301 S HUNTINGTON AVE
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4807
Country	:	US
Telephone Number	:	857-307-3365
Fax Number	:	857-307-3305

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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