Provider Demographics
NPI:1851900518
Name:CLEVELAND, KAILYN KYRINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:KYRINE
Last Name:CLEVELAND
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 1:700 E AVALON
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634
Mailing Address - Country:US
Mailing Address - Phone:208-789-4188
Mailing Address - Fax:
Practice Address - Street 1:700 E AVALON
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634
Practice Address - Country:US
Practice Address - Phone:208-789-4188
Practice Address - Fax:208-922-3568
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist