Provider Demographics
NPI:1104557800
Name:MARIKAR, KAILEE
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:MARIKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S ROCKING HORSE LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7213
Mailing Address - Country:US
Mailing Address - Phone:602-885-6669
Mailing Address - Fax:
Practice Address - Street 1:4910 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2846
Practice Address - Country:US
Practice Address - Phone:928-526-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38324183700000X
TX70784183500000X
AZS026397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician