Provider Demographics
NPI:1912413964
Name:BAHNSON, KAYLYN BROOK
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:BROOK
Last Name:BAHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SOUTH DOUGLAS HWY WALGREENS PHARMACY
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718
Mailing Address - Country:US
Mailing Address - Phone:307-682-4517
Mailing Address - Fax:
Practice Address - Street 1:2000 SOUTH DOUGLAS HWY WALGREENS PHARMACY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-682-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4041183500000X
SD6543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist