Provider Demographics
NPI:1336471721
Name:WARNER, KIERA E (RPH)
Entity Type:Individual
Prefix:DR
First Name:KIERA
Middle Name:E
Last Name:WARNER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9396 FIVE MILE LINE RD
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4126
Mailing Address - Country:US
Mailing Address - Phone:315-393-7931
Mailing Address - Fax:
Practice Address - Street 1:40 STATE HIGHWAY 310
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1459
Practice Address - Country:US
Practice Address - Phone:315-386-4563
Practice Address - Fax:315-386-4332
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist