Provider Demographics
NPI:1598437972
Name:GIERLACH, KEVIN SAMUEL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SAMUEL
Last Name:GIERLACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 SUMMIT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1432
Mailing Address - Country:US
Mailing Address - Phone:724-656-9393
Mailing Address - Fax:
Practice Address - Street 1:2500 LOVI RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:15042-9398
Practice Address - Country:US
Practice Address - Phone:724-683-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042628L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist