Kaitlin Kelly, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

28RI03970000 Issued in NJ

Practice address

217 Harrison St
Nutley, NJ 07110-2637

Phone

(973) 667-5773

NPI assigned

Jan 19, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1013669209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MACE ST",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103061443",
            "telephone_number": "646-243-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 HARRISON ST",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071102637",
            "telephone_number": "973-667-5773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KAITLIN",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RI03970000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0803",
            "identifier": "0803",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "CVS1158",
            "affiliation": "N",
            "endpointDescription": "pharmacy store",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "217 Harrison St",
            "city": "Nutley",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "071102637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taji S. Karim-Reisch, LCSW
• Robin Karpenski
• John Kaufman, PT
• Amy C. Kayda, LPC
• Marcia Joan Kaye, MSW LCSW
• Jenna Kennedy
• Justine Marie Kent, MD
• Ann Kerin
• Jude Marley Kernizan, DC
• Mark I Khaimov, DDS

• Pharmacist in Nutley, NJ
• Providers in Nutley, NJ by specialty
• Pharmacist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.