Healthcare Provider Details

I. General information

NPI: 1992085120
Provider Name (Legal Business Name): JENNIFER LYNN KILANOWSKI PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 WEST 26TH STREET
ERIE PA
16509
US

IV. Provider business mailing address

647 EAST 10TH STREET
ERIE PA
16503-1315
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-4012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: