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General NPI Number Information
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NPI Number | 1619002938
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Entity Type | Organization
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Legal Business Name | KINSLEYS MARKET OF TANNERSVILLE INC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 107 KINSLEY DR
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-7800
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Country | US
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Telephone | 570-992-2670
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Fax | 570-992-2877
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Provider Business Mailing Address
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Address Line | PO BOX 760
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City | BRODHEADSVILLE
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State | PA
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Zip | 18322-0760
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Country | US
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Telephone | 570-992-2670
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Fax | 570-992-2877
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Authorized Official
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Title or Position | THIRD PARTY ADMINISTRATOR
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Name | MISS MELISSA FIGUEROA RIVERA
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Credential |
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Telephone | 732-521-8439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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