Provider Demographics
NPI:1770467656
Name:KIRBY, KAITLYN BROOKE (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:BROOKE
Last Name:KIRBY
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 1:610 BASINGER RD
Mailing Address - Street 2:
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-9754
Mailing Address - Country:US
Mailing Address - Phone:419-764-4798
Mailing Address - Fax:
Practice Address - Street 1:511 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1201
Practice Address - Country:US
Practice Address - Phone:419-772-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03445784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist