Provider Demographics
NPI:1790380582
Name:KOTROZO, KELLY ANN I
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:KOTROZO
Suffix:I
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 1:11240 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8332
Mailing Address - Country:US
Mailing Address - Phone:724-935-7890
Mailing Address - Fax:724-935-7895
Practice Address - Street 1:11240 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8332
Practice Address - Country:US
Practice Address - Phone:724-935-7890
Practice Address - Fax:724-935-7895
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038180L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist