Provider Demographics
NPI:1306618327
Name:DOUBET, KAYLEE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:DOUBET
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 1:16177 E BLACKFOOT DR
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:IL
Mailing Address - Zip Code:61427-9499
Mailing Address - Country:US
Mailing Address - Phone:309-634-9949
Mailing Address - Fax:
Practice Address - Street 1:910 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4816
Practice Address - Country:US
Practice Address - Phone:309-634-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist