Healthcare Provider Details

I. General information

NPI: 1285204156
Provider Name (Legal Business Name): KAITLIN R CARLSON PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

837 COLCHESTER REEF RUN
SNEADS FERRY NC
28460-1409
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4357
  • Fax:
Mailing address:
  • Phone: 320-492-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2865M2000X
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2865M2000X
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: