Provider Demographics
NPI:1992316004
Name:BRAHM, KAYLA NICOLE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:BRAHM
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 1:6707 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3442
Mailing Address - Country:US
Mailing Address - Phone:585-360-1814
Mailing Address - Fax:
Practice Address - Street 1:6707 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3442
Practice Address - Country:US
Practice Address - Phone:585-360-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66542183500000X
NY069727183500000X
VT033.0134285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist