Provider Demographics
NPI:1669844981
Name:WHITE, KAITLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WHITE
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 1:151 VERMONT ROUTE 12 S
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-9237
Mailing Address - Country:US
Mailing Address - Phone:802-728-6284
Mailing Address - Fax:
Practice Address - Street 1:151 VERMONT ROUTE 12 S
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-9237
Practice Address - Country:US
Practice Address - Phone:802-728-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0104333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist