Healthcare Provider Details

I. General information

NPI: 1053928952
Provider Name (Legal Business Name): KATHRYN GRACE CUERVO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COLLIERS WAY
WEIRTON WV
26062-5014
US

IV. Provider business mailing address

140 WESTBROOKE LN
CORAOPOLIS PA
15108-9139
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6070
  • Fax:
Mailing address:
  • Phone: 412-352-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0011164
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: