Healthcare Provider Details

I. General information

NPI: 1104557800
Provider Name (Legal Business Name): KAILEE MARIKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 N US HIGHWAY 89
FLAGSTAFF AZ
86004-2846
US

IV. Provider business mailing address

2245 S ROCKING HORSE LN
FLAGSTAFF AZ
86001-7213
US

V. Phone/Fax

Practice location:
  • Phone: 928-526-6116
  • Fax:
Mailing address:
  • Phone: 602-885-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70784
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026397
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number38324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: