Provider Demographics
NPI:1003416702
Name:BADZGON, KIERSTEN LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIERSTEN
Middle Name:LYNN
Last Name:BADZGON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ADDIE CT APT 214
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-4219
Mailing Address - Country:US
Mailing Address - Phone:412-266-0643
Mailing Address - Fax:
Practice Address - Street 1:500 OLD POND RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1272
Practice Address - Country:US
Practice Address - Phone:412-257-1263
Practice Address - Fax:412-257-1266
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI013326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist