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General NPI Number Information
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NPI Number | 1164914081
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Entity Type | Individual
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Provider Name | SAMANTHA LYNN KUNKEL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 175 S WILKES BARRE BLVD
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City | WILKES BARRE
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State | PA
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Zip | 18702-5040
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Country | US
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Telephone | 157-082-9262
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Fax |
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Provider Business Mailing Address
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Address Line | 16 WESTMINSTER DR
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City | DALLAS
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State | PA
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Zip | 18612-1415
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Country | US
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Telephone | 607-237-6600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP451624
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License Number State | PA
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