MEDICARE: DR. RENEE LYNN KURDILLA PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP440957	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP440957	OTHER	PA	PHARMACIST STATE LICENSE

General Provider Information

NPI Number	:	1063720449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE LYNN KURDILLA PHARM D

Provider Business Mailing Address
First Line	:	205 ROOSEVELT ST
Second Line	:
City	:	BELLE VERNON
State	:	PA
Zip	:	15012-2063
Country	:	US
Telephone Number	:	724-929-8896
Fax Number	:

Provider Business Practice Location Address
First Line	:	6039 NATIONAL PIKE
Second Line	:
City	:	GRINDSTONE
State	:	PA
Zip	:	15442-1107
Country	:	US
Telephone Number	:	724-785-4522
Fax Number	:	724-785-2863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	09/20/2010

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