Healthcare Provider Details

I. General information

NPI: 1245834225
Provider Name (Legal Business Name): KAITLIN OLDERHAM PHARMD, R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN GREGORY

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W HARDING RD
SPRINGFIELD OH
45504-1707
US

IV. Provider business mailing address

2934 OLD TROON DR APT D
BEAVERCREEK OH
45324-7518
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-8531
  • Fax:
Mailing address:
  • Phone: 937-207-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03440168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: