MEDICARE: TINA KISTLER TINA KISTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP036867L	PA

General Provider Information

NPI Number	:	1336448141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA KISTLER TINA KISTLER

Provider Business Mailing Address
First Line	:	5826 SUN VALLEY RUN
Second Line	:
City	:	ZIONSVILLE
State	:	PA
Zip	:	18092-2043
Country	:	US
Telephone Number	:	610-967-5695
Fax Number	:

Provider Business Practice Location Address
First Line	:	6822 HAMILTON BLVD
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18106-9644
Country	:	US
Telephone Number	:	610-398-1351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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