Provider Demographics
NPI:1336448141
Name:KISTLER, TINA (TINA KISTLER)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KISTLER
Suffix:
Gender:F
Credentials:TINA KISTLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 SUN VALLEY RUN
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18092-2043
Mailing Address - Country:US
Mailing Address - Phone:610-967-5695
Mailing Address - Fax:
Practice Address - Street 1:6822 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9644
Practice Address - Country:US
Practice Address - Phone:610-398-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036867L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist