Provider Demographics
NPI:1245834225
Name:OLDERHAM, KAITLIN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:OLDERHAM
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2934 OLD TROON DR APT D
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45324-7518
Mailing Address - Country:US
Mailing Address - Phone:937-207-2278
Mailing Address - Fax:
Practice Address - Street 1:400 W HARDING RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1707
Practice Address - Country:US
Practice Address - Phone:937-399-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist