Healthcare Provider Details

I. General information

NPI: 1558981266
Provider Name (Legal Business Name): KIMBERLY ANN CRAUGHAN CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE STE 111
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

1510 KNIGHTS DR APT 340
SOUTH PARK PA
15129-8622
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-8677
  • Fax:
Mailing address:
  • Phone: 971-808-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number560107010212271
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: