Provider Demographics
NPI:1518568682
Name:MERTIFF, KYLEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:MERTIFF
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5204
Mailing Address - Country:US
Mailing Address - Phone:814-940-2554
Mailing Address - Fax:814-940-2565
Practice Address - Street 1:200 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5204
Practice Address - Country:US
Practice Address - Phone:814-940-2554
Practice Address - Fax:814-940-2565
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist