Provider Demographics
NPI:1104535491
Name:THOMAS, KAITLYN (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:THOMAS
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 1:1680 SW ANKENY RD APT 309
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8348
Mailing Address - Country:US
Mailing Address - Phone:815-243-8197
Mailing Address - Fax:
Practice Address - Street 1:107 NE DELAWARE AVE STE 6
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6691
Practice Address - Country:US
Practice Address - Phone:515-964-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist