Provider Demographics
NPI:1821450487
Name:NESTEL, KURT RICHARD JR (BSPH)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:RICHARD
Last Name:NESTEL
Suffix:JR
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1101
Mailing Address - Country:US
Mailing Address - Phone:814-541-5379
Mailing Address - Fax:
Practice Address - Street 1:207 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1101
Practice Address - Country:US
Practice Address - Phone:814-541-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037585L183500000X
AZS013254183500000X
OHRPH.03224940-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist