Individual
KAITLIN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
217 HARRISON ST, NUTLEY, NJ 07110-2637
(973) 667-5773
Mailing address
120 MACE ST, STATEN ISLAND, NY 10306-1443
(646) 243-5620
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03970000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803
0803
—
Enumeration date
01/19/2022
Last updated
01/19/2022
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