Healthcare Provider Details

I. General information

NPI: 1215312921
Provider Name (Legal Business Name): KAITLYN ROSE KUPFERER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 HOWARD AVE UNIT 301
MYRTLE BEACH SC
29577-1914
US

IV. Provider business mailing address

3095 HOWARD AVE SUITE 301
MYRTLE BEACH SC
29577-1914
US

V. Phone/Fax

Practice location:
  • Phone: 330-550-1729
  • Fax:
Mailing address:
  • Phone: 330-550-1729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36216
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: