Healthcare Provider Details

I. General information

NPI: 1932727799
Provider Name (Legal Business Name): KAITLYN STARR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

97 TANGLEWOOD DR W
ORCHARD PARK NY
14127-3507
US

V. Phone/Fax

Practice location:
  • Phone: 716-435-6950
  • Fax:
Mailing address:
  • Phone: 716-435-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI064575
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberI064575
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: