Provider Demographics
NPI:1710403472
Name:BONDS, KAITLYN RAYANNE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RAYANNE
Last Name:BONDS
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 1:201 MARINA DR APT 1413
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3245
Mailing Address - Country:US
Mailing Address - Phone:256-302-0889
Mailing Address - Fax:
Practice Address - Street 1:4400 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5104
Practice Address - Country:US
Practice Address - Phone:205-553-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist