Provider Demographics
NPI:1396036968
Name:THIERMAN, KELLIE D
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:D
Last Name:THIERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3354
Mailing Address - Country:US
Mailing Address - Phone:814-336-3773
Mailing Address - Fax:814-333-8347
Practice Address - Street 1:975 MARKET ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3354
Practice Address - Country:US
Practice Address - Phone:814-336-3773
Practice Address - Fax:814-333-8347
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007565183500000X
PARP445078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist