MEDICARE: DR. KAITLIN ANN PRUSKOWSKI PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835C0205X	Critical Care Pharmacist	22526	MD
2	1835C0205X	Critical Care Pharmacist	RPI008687	PA
3	1835C0205X	Critical Care Pharmacist	RP448789	PA
4	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	22526	MD
5	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP448789	PA

General Provider Information

NPI Number	:	1528516523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAITLIN ANN PRUSKOWSKI PHARMD

Provider Business Mailing Address
First Line	:	633 S SAINT MARYS ST
Second Line	:	APT 5208
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-3493
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3698 CHAMBERS PASS
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7766
Country	:	US
Telephone Number	:	210-916-2876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	08/07/2023

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