Provider Demographics
NPI:1063139061
Name:BROTHERTON, KAYLA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CLEMENS CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8905
Mailing Address - Country:US
Mailing Address - Phone:321-795-5688
Mailing Address - Fax:
Practice Address - Street 1:217 CLEMENS CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8905
Practice Address - Country:US
Practice Address - Phone:321-795-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU9466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist