MEDICARE: DR. KAITLYN EDER PHARMD, RPH

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	183500000X	Pharmacist	03236979	OH

General Provider Information

NPI Number	:	1134772346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAITLYN EDER PHARMD, RPH

Provider Business Mailing Address
First Line	:	6849 SOUTHLAND DR
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3632
Country	:	US
Telephone Number	:	440-884-4171
Fax Number	:

Provider Business Practice Location Address
First Line	:	6849 SOUTHLAND DR
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3632
Country	:	US
Telephone Number	:	440-884-4171
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	11/09/2020

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