Healthcare Provider Details

I. General information

NPI: 1346818200
Provider Name (Legal Business Name): KAYLA BRACKMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

3829 MILLSBRAE AVE APT 3
CINCINNATI OH
45209-2217
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03337266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: