Provider Demographics
NPI:1093306508
Name:BOVA, KAITLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BOVA
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 1:192 THORNDIKE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1534
Mailing Address - Country:US
Mailing Address - Phone:814-464-4799
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3846
Practice Address - Country:US
Practice Address - Phone:978-470-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist