Provider Demographics
NPI:1639779671
Name:KITZMILLER, CARRIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KITZMILLER
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 1:544 PINEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-7409
Mailing Address - Country:US
Mailing Address - Phone:304-788-3468
Mailing Address - Fax:
Practice Address - Street 1:148 WALMART DR
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-1805
Practice Address - Country:US
Practice Address - Phone:304-788-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist