Healthcare Provider Details

I. General information

NPI: 1407969892
Provider Name (Legal Business Name): MS. KRISTEN MARIE TREMBLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 WASHINGTON ST
ELMIRA NY
14901-3220
US

IV. Provider business mailing address

2898 WESTINGHOUSE RD
HORSEHEADS NY
14845-8196
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-2056
  • Fax:
Mailing address:
  • Phone: 607-796-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR1899
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: