Provider Demographics
NPI:1770188476
Name:KENNETT-HAYES, KAITLYN MICHELE (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MICHELE
Last Name:KENNETT-HAYES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MICHELE
Other - Last Name:KENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10560 4S COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10560 4S COMMONS DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3511
Practice Address - Country:US
Practice Address - Phone:858-673-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist