Provider Demographics
NPI:1225719107
Name:CAGUITLA, KEVIN B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:CAGUITLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 EDBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-4568
Mailing Address - Country:US
Mailing Address - Phone:702-513-0417
Mailing Address - Fax:
Practice Address - Street 1:6854 PARKER RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5313
Practice Address - Country:US
Practice Address - Phone:702-513-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist