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NPI Code Detail

MEDICARE: MARK DAVID KINNER

MEDICARE: MARK DAVID KINNER
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
1183500000XPharmacist032567NY
2183500000XPharmacistRP029528LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083896963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK DAVID KINNER
Provider Business Mailing Address
First Line : 387 PENNSYLVANIA AVE
Second Line :
City : SAYRE
State : PA
Zip : 18840-9279
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1593 ELMIRA ST
Second Line :
City : SAYRE
State : PA
Zip : 18840-9254
Country : US
Telephone Number : 570-888-2369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2007
Last Update Date : 12/03/2007

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Directions to “ MARK DAVID KINNER ” Practice Location

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