Healthcare Provider Details

I. General information

NPI: 1255924866
Provider Name (Legal Business Name): KATHLEEN MIRABEL LLARENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ROOSEVELT AVE
YORK PA
17408-8506
US

IV. Provider business mailing address

1800 ROOSEVELT AVE
YORK PA
17408-8506
US

V. Phone/Fax

Practice location:
  • Phone: 717-767-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPI120804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: