Provider Demographics
NPI:1215478243
Name:ANDRIES, KAITLYN (PHARM D)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ANDRIES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 SOMMERSBY ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-9406
Mailing Address - Country:US
Mailing Address - Phone:269-998-7464
Mailing Address - Fax:
Practice Address - Street 1:724 SOMMERSBY ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9406
Practice Address - Country:US
Practice Address - Phone:269-998-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist