Healthcare Provider Details

I. General information

NPI: 1871194159
Provider Name (Legal Business Name): KATELYN KINKLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TED DR
PINE BUSH NY
12566-7032
US

IV. Provider business mailing address

31 TED DR
PINE BUSH NY
12566-7032
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-4827
  • Fax:
Mailing address:
  • Phone: 845-744-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: