Healthcare Provider Details

I. General information

NPI: 1376408955
Provider Name (Legal Business Name): KAITLYN KNUREK PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W JIMMIE LEEDS RD
POMONA NJ
08240-9102
US

IV. Provider business mailing address

16 CONGRESS LN
SOUTH RIVER NJ
08882-2579
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-1000
  • Fax:
Mailing address:
  • Phone: 732-306-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04472500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: