Healthcare Provider Details

I. General information

NPI: 1467995811
Provider Name (Legal Business Name): KAITLYN HOTZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 S WESTERN AVE
MARION IN
46953-4901
US

IV. Provider business mailing address

1514 N LAKESHORE DR
MARION IN
46952-1586
US

V. Phone/Fax

Practice location:
  • Phone: 765-677-6810
  • Fax:
Mailing address:
  • Phone: 765-618-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26024551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: