Healthcare Provider Details

I. General information

NPI: 1871078022
Provider Name (Legal Business Name): KAITLIN FRY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 AUGUSTA RD
WARRENVILLE SC
29851
US

IV. Provider business mailing address

409 MUDDY SPRINGS RD
LEXINGTON SC
29073-8689
US

V. Phone/Fax

Practice location:
  • Phone: 803-593-3411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37984
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: