Provider Demographics
NPI:1235867979
Name:DISKIN, KAYTLYNN SHELBI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYTLYNN
Middle Name:SHELBI
Last Name:DISKIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAYTLYNN
Other - Middle Name:SHELBI
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 PRESLEY LN
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-9311
Mailing Address - Country:US
Mailing Address - Phone:304-995-5791
Mailing Address - Fax:
Practice Address - Street 1:201 MARANTO MANOR DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4807
Practice Address - Country:US
Practice Address - Phone:540-868-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist