Provider Demographics
NPI:1790392496
Name:IANIRO, KAITLIN T (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:T
Last Name:IANIRO
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 1:382 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-2100
Mailing Address - Country:US
Mailing Address - Phone:845-857-7674
Mailing Address - Fax:
Practice Address - Street 1:382 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-2100
Practice Address - Country:US
Practice Address - Phone:845-857-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI067053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist