Healthcare Provider Details

I. General information

NPI: 1700435542
Provider Name (Legal Business Name): KAITLYN MARIE HOLYFIELD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAINWRIGHT DR
WALLA WALLA WA
99362-3975
US

IV. Provider business mailing address

1401 SW GREELEY ST
COLLEGE PLACE WA
99324-5005
US

V. Phone/Fax

Practice location:
  • Phone: 509-526-6243
  • Fax:
Mailing address:
  • Phone: 801-550-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9061367
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: