Provider Demographics
NPI:1790822005
Name:WURZLER, KELLY LYNNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNNE
Last Name:WURZLER
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:RR 2 BOX 2121
Mailing Address - Street 2:
Mailing Address - City:LACEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18623
Mailing Address - Country:US
Mailing Address - Phone:570-869-2958
Mailing Address - Fax:
Practice Address - Street 1:137 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WYALUSING
Practice Address - State:PA
Practice Address - Zip Code:18853
Practice Address - Country:US
Practice Address - Phone:570-746-1004
Practice Address - Fax:570-746-9470
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist