Healthcare Provider Details

I. General information

NPI: 1336471721
Provider Name (Legal Business Name): KIERA E WARNER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 STATE HIGHWAY 310
CANTON NY
13617-1459
US

IV. Provider business mailing address

9396 FIVE MILE LINE RD
OGDENSBURG NY
13669-4126
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-4563
  • Fax: 315-386-4332
Mailing address:
  • Phone: 315-393-7931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: