Healthcare Provider Details

I. General information

NPI: 1689286452
Provider Name (Legal Business Name): KAITLIN GARRETT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E LOHMAN AVE
LAS CRUCES NM
88001-8492
US

IV. Provider business mailing address

4202 TRES NINOS # B
LAS CRUCES NM
88011-4343
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-2506
  • Fax:
Mailing address:
  • Phone: 575-607-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009340
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: