Provider Demographics
NPI:1538037627
Name:KIRKPATRICK, KAITLYN ANN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:KIRKPATRICK
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 1:600 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1940
Mailing Address - Country:US
Mailing Address - Phone:973-939-9021
Mailing Address - Fax:
Practice Address - Street 1:600 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1940
Practice Address - Country:US
Practice Address - Phone:973-939-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04467700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist