Provider Demographics
NPI:1831610492
Name:PEPE, CAITLYN ILYSSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAITLYN
Middle Name:ILYSSA
Last Name:PEPE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CAITLYN
Other - Middle Name:ILYSSA
Other - Last Name:BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:43 MERRIVALE DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4449
Mailing Address - Country:US
Mailing Address - Phone:631-355-5313
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY CENTER DR STE 600
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4749
Practice Address - Country:US
Practice Address - Phone:781-566-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03812000183500000X
NY062713I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist