Provider Demographics
NPI:1609500396
Name:ROSS, KAITLIN SUZANNE (CPHT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SUZANNE
Last Name:ROSS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:10 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-3290
Mailing Address - Country:US
Mailing Address - Phone:509-671-7417
Mailing Address - Fax:
Practice Address - Street 1:618 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1609
Practice Address - Country:US
Practice Address - Phone:419-782-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09317121183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician