Provider Demographics
NPI:1144638578
Name:MAXWELL, KAYLA A (PHARMD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:A
Last Name:MAXWELL
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 1:45 S CAYUGA RD
Mailing Address - Street 2:BUILDING K APARTMENT 2
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6748
Mailing Address - Country:US
Mailing Address - Phone:716-512-3026
Mailing Address - Fax:
Practice Address - Street 1:2545 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1445
Practice Address - Country:US
Practice Address - Phone:716-688-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist