Provider Demographics
NPI:1912383399
Name:JAYKEL, KAITLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:JAYKEL
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 1:501 WILLARD ST APT 302
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3288
Mailing Address - Country:US
Mailing Address - Phone:330-671-6704
Mailing Address - Fax:
Practice Address - Street 1:5350 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3304
Practice Address - Country:US
Practice Address - Phone:269-349-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043477183500000X
OH03334454-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist