Healthcare Provider Details

I. General information

NPI: 1235066234
Provider Name (Legal Business Name): COURTNEY KINKEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 MOUNTAIN LAUREL PLZ
LATROBE PA
15650-5214
US

IV. Provider business mailing address

1050 MOUNTAIN LAUREL PLZ
LATROBE PA
15650-5214
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-4995
  • Fax: 724-537-5197
Mailing address:
  • Phone: 724-537-4995
  • Fax: 724-537-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP460265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: