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General NPI Number Information
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NPI Number | 1457888059
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Entity Type | Individual
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Provider Name | TIMOTHY JOHN KUNKLE
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Gender | Male
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 05/15/2017
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Provider Practice Location Address
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Address Line | 1212 2ND ST
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City | CRESSON
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State | PA
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Zip | 16630-1148
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Country | US
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Telephone | 814-886-2677
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Fax | 814-884-0175
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Provider Business Mailing Address
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Address Line | 49 MORNINGSIDE DR
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City | INDIANA
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State | PA
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Zip | 15701-3613
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Country | US
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Telephone | 724-388-2200
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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 | RP438735
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License Number State | PA
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