Healthcare Provider Details

I. General information

NPI: 1891006284
Provider Name (Legal Business Name): MRS. KATHLEEN ANNE MONTANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KATHLEEN ANNE VALANTE

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 CHESTNUT ST
UNION NJ
07083-9426
US

IV. Provider business mailing address

50 GERTRUDE ST
CLARK NJ
07066-3212
US

V. Phone/Fax

Practice location:
  • Phone: 908-686-1212
  • Fax: 908-686-7343
Mailing address:
  • Phone: 732-770-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02163200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03118900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: