Healthcare Provider Details

I. General information

NPI: 1619760691
Provider Name (Legal Business Name): KRISTEN ANN BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 N MAIN ST
PITTSTON PA
18640-1916
US

IV. Provider business mailing address

124 LATHROP ST
KINGSTON PA
18704-4811
US

V. Phone/Fax

Practice location:
  • Phone: 570-655-1489
  • Fax:
Mailing address:
  • Phone: 570-814-9543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP042960L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP042906L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: