Healthcare Provider Details

I. General information

NPI: 1861809899
Provider Name (Legal Business Name): JOHN KINNIE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 NATIONAL HWY
LAVALE MD
21502-7603
US

IV. Provider business mailing address

1202 NATIONAL HWY
LAVALE MD
21502-7603
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17211
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: