Healthcare Provider Details

I. General information

NPI: 1336448141
Provider Name (Legal Business Name): TINA KISTLER TINA KISTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6822 HAMILTON BLVD
ALLENTOWN PA
18106-9644
US

IV. Provider business mailing address

5826 SUN VALLEY RUN
ZIONSVILLE PA
18092-2043
US

V. Phone/Fax

Practice location:
  • Phone: 610-398-1351
  • Fax:
Mailing address:
  • Phone: 610-967-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036867L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: