Provider Demographics
NPI:1083029284
Name:HARTIN, KAITLIN DAVIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:DAVIS
Last Name:HARTIN
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 1:4900 ROGERS AVE STE 101J
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2068
Mailing Address - Country:US
Mailing Address - Phone:479-484-9125
Mailing Address - Fax:
Practice Address - Street 1:4900 ROGERS AVE STE 101J
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2068
Practice Address - Country:US
Practice Address - Phone:479-484-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist