Provider Demographics
NPI:1316547896
Name:MCCANN, KAITLIN BROOKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:BROOKE
Last Name:MCCANN
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 1:75 RIVERFRONT DR APT 448
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5779
Mailing Address - Country:US
Mailing Address - Phone:501-259-2637
Mailing Address - Fax:
Practice Address - Street 1:8824 GEYER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4765
Practice Address - Country:US
Practice Address - Phone:501-565-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD154421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist