Provider Demographics
NPI:1083145080
Name:O'ROURKE, KAITLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:O'ROURKE
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 1:301 S HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4807
Mailing Address - Country:US
Mailing Address - Phone:857-307-3365
Mailing Address - Fax:857-307-3305
Practice Address - Street 1:301 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4807
Practice Address - Country:US
Practice Address - Phone:857-307-3365
Practice Address - Fax:857-307-3305
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2336091835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care