Healthcare Provider Details

I. General information

NPI: 1750785846
Provider Name (Legal Business Name): AUTUMN REBECCA KUZY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GRANDVIEW CROSSING DR
GIBSONIA PA
15044-7100
US

IV. Provider business mailing address

31 HARMON HILLS LN
WASHINGTON PA
15301-7706
US

V. Phone/Fax

Practice location:
  • Phone: 724-799-2238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449264
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: