Provider Demographics
NPI:1134772346
Name:EDER, KAITLYN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:EDER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3632
Mailing Address - Country:US
Mailing Address - Phone:440-884-4171
Mailing Address - Fax:
Practice Address - Street 1:6849 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3632
Practice Address - Country:US
Practice Address - Phone:440-884-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03236979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist