Provider Demographics
NPI:1215549365
Name:GUERTIN, KAITLIN ANN
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:GUERTIN
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 1:209 STELLA WAY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-5405
Mailing Address - Country:US
Mailing Address - Phone:951-537-4856
Mailing Address - Fax:
Practice Address - Street 1:9539 CLIFFDALE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5956
Practice Address - Country:US
Practice Address - Phone:910-860-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist