Provider Demographics
NPI:1114692035
Name:TYLER, KAITLIN COMEAUX (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:COMEAUX
Last Name:TYLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:COMEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2301
Mailing Address - Country:US
Mailing Address - Phone:337-577-3460
Mailing Address - Fax:
Practice Address - Street 1:4400 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6760
Practice Address - Country:US
Practice Address - Phone:337-984-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist