Provider Demographics
NPI:1669945341
Name:CALLOWAY, KAYLA LANAE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:LANAE
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:LANAE
Other - Last Name:BESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1460 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7174
Mailing Address - Country:US
Mailing Address - Phone:386-760-3078
Mailing Address - Fax:
Practice Address - Street 1:1460 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-760-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015023947183500000X
FLPS53744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist