Provider Demographics
NPI:1902402340
Name:CLARE, KAYLA
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:CLARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 NE 54TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:FL
Mailing Address - Zip Code:33521
Mailing Address - Country:US
Mailing Address - Phone:352-689-5282
Mailing Address - Fax:
Practice Address - Street 1:6217 SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4229
Practice Address - Country:US
Practice Address - Phone:407-298-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217055183500000X
FLPS58988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist