Provider Demographics
NPI:1144749888
Name:PARKS, KAILTYN TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAILTYN
Middle Name:TAYLOR
Last Name:PARKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:TAYLOR
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:605 E FIGZEL CT APT 204
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-2524
Mailing Address - Country:US
Mailing Address - Phone:615-504-3147
Mailing Address - Fax:
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1305
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN416551835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist