| NPI | 1831610492 |
|---|---|
| Former Name | CAITLYN ILYSSA BLOOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 062713I) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03812000) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2023-08-17 |