Healthcare Provider Details

I. General information

NPI: 1801520473
Provider Name (Legal Business Name): KATHLEEN HURD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 ROUTE 31 SUITE 4
CICERO NY
13039-7857
US

IV. Provider business mailing address

8900 BLACKTHORN LN
LIVERPOOL NY
13090-1595
US

V. Phone/Fax

Practice location:
  • Phone: 888-407-8015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03334405
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449231
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD16024
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: