Provider Demographics
NPI:1720679251
Name:SKELTON, KAILEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:SKELTON
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 1:4626 N MARYLAND AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-3668
Mailing Address - Country:US
Mailing Address - Phone:503-990-2208
Mailing Address - Fax:
Practice Address - Street 1:1500 SW 1ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5830
Practice Address - Country:US
Practice Address - Phone:503-699-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019193183500000X
WAIR60972709390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0019193OtherOREGON BOARD OF PHARMACY
ORPI-0013567OtherOREGON BOARD OF PHARMACY