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NPI Code Detail

MEDICARE: CHRISTYAN KENNEDY ALLAN RPH

MEDICARE: CHRISTYAN KENNEDY ALLAN RPH
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
1183500000XPharmacistRP041012LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RP041012LOTHERPALICENSE NUMBER

General Provider Information

NPI Number : 1710209002
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTYAN KENNEDY ALLAN RPH
Provider Business Mailing Address
First Line : 1566 W MAIN STREET EXT
Second Line :
City : GROVE CITY
State : PA
Zip : 16127-4432
Country : US
Telephone Number : 724-458-5977
Fax Number : 724-458-0538
Provider Business Practice Location Address
First Line : 1566 W MAIN STREET EXT
Second Line :
City : GROVE CITY
State : PA
Zip : 16127-4432
Country : US
Telephone Number : 724-458-5977
Fax Number : 724-458-0538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2010
Last Update Date : 02/27/2010

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