Provider Demographics
NPI:1710795943
Name:GARRIS, KAYLA NYCOHL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:NYCOHL
Last Name:GARRIS
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 1:2849 DALLAS ST NW APT 1702
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2295
Mailing Address - Country:US
Mailing Address - Phone:919-523-0527
Mailing Address - Fax:
Practice Address - Street 1:6095 PINE MOUNTAIN RD NW STE 108
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3332
Practice Address - Country:US
Practice Address - Phone:770-421-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist