Provider Demographics
NPI:1619575115
Name:DUPUIS, KAITLYN ALYSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALYSE
Last Name:DUPUIS
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 1:129 SMITH LN
Mailing Address - Street 2:
Mailing Address - City:CANKTON
Mailing Address - State:LA
Mailing Address - Zip Code:70584-5832
Mailing Address - Country:US
Mailing Address - Phone:337-207-9419
Mailing Address - Fax:
Practice Address - Street 1:208 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-4009
Practice Address - Country:US
Practice Address - Phone:337-896-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist