Healthcare Provider Details

I. General information

NPI: 1477178143
Provider Name (Legal Business Name): KAYLA LYNN PLISKA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 09/30/2022
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 UHRMANN RD
KLAMATH FALLS OR
97601-1123
US

IV. Provider business mailing address

3818 CLINTON AVE
KLAMATH FALLS OR
97603-7308
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-4833
  • Fax: 541-274-4805
Mailing address:
  • Phone: 541-225-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0016849
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: