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General NPI Number Information
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NPI Number | 1013669209
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Entity Type | Individual
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Provider Name | KAITLIN KELLY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 217 HARRISON ST
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City | NUTLEY
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State | NJ
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Zip | 07110-2637
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Country | US
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Telephone | 973-667-5773
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Fax |
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Provider Business Mailing Address
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Address Line | 120 MACE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-1443
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Country | US
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Telephone | 646-243-5620
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03970000
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License Number State | NJ
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