Provider Demographics
NPI:1689286452
Name:GARRETT, KAITLIN (RPH)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 TRES NINOS # B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4343
Mailing Address - Country:US
Mailing Address - Phone:575-607-5263
Mailing Address - Fax:
Practice Address - Street 1:2300 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8492
Practice Address - Country:US
Practice Address - Phone:575-647-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist