Provider Demographics
NPI:1528516523
Name:PRUSKOWSKI, KAITLIN ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ANN
Last Name:PRUSKOWSKI
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 1:633 S SAINT MARYS ST
Mailing Address - Street 2:APT 5208
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-3493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3698 CHAMBERS PASS
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7766
Practice Address - Country:US
Practice Address - Phone:210-916-2876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225261835C0205X, 1835P0018X
PARPI0086871835C0205X
PARP4487891835C0205X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835C0205XPharmacy Service ProvidersPharmacistCritical Care