Healthcare Provider Details

I. General information

NPI: 1528984259
Provider Name (Legal Business Name): KAYLEE CLARK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

335 VISTA DR
GAHANNA OH
43230-5900
US

V. Phone/Fax

Practice location:
  • Phone: 937-267-1498
  • Fax:
Mailing address:
  • Phone: 937-267-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03446780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: