Provider Demographics
NPI:1871032383
Name:WIVAGG, KYRSTEN ALEXIS ZUBROD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KYRSTEN
Middle Name:ALEXIS ZUBROD
Last Name:WIVAGG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KYRSTEN
Other - Middle Name:ALEXIS
Other - Last Name:ZUBROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:300 HALKET STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-641-4356
Mailing Address - Fax:
Practice Address - Street 1:300 HALKET STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-641-4356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045564L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist