Provider Demographics
NPI:1265261903
Name:THERRELL, KAITLYN E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:E
Last Name:THERRELL
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 1:102 E HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-3113
Mailing Address - Country:US
Mailing Address - Phone:478-919-6231
Mailing Address - Fax:
Practice Address - Street 1:6015 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6650
Practice Address - Country:US
Practice Address - Phone:478-953-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist