Provider Demographics
NPI:1013517564
Name:PELTIER, KAYLA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:MARIE
Last Name:PELTIER
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 1:8585 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-7012
Mailing Address - Country:US
Mailing Address - Phone:409-724-0054
Mailing Address - Fax:409-722-6964
Practice Address - Street 1:8585 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-7012
Practice Address - Country:US
Practice Address - Phone:409-724-0054
Practice Address - Fax:409-722-6964
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist