Healthcare Provider Details

I. General information

NPI: 1841571775
Provider Name (Legal Business Name): ELIZABETH KUKIELKA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH WINTERS

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N BRADFORD AVENUE
WEST CHESTER PA
19380
US

IV. Provider business mailing address

300 N BRADFORD AVENUE
WEST CHESTER PA
19380
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-0145
  • Fax: 610-696-0260
Mailing address:
  • Phone: 610-696-0145
  • Fax: 610-696-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442664
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003786
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20044
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: