Healthcare Provider Details

I. General information

NPI: 1396347662
Provider Name (Legal Business Name): DORE ELLEN KOTTLER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 W TILGHMAN ST
ALLENTOWN PA
18104-4208
US

IV. Provider business mailing address

3070 W TILGHMAN ST
ALLENTOWN PA
18104-4208
US

V. Phone/Fax

Practice location:
  • Phone: 610-351-2091
  • Fax:
Mailing address:
  • Phone: 610-351-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP037497R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: