Provider Demographics
NPI:1457888059
Name:KUNKLE, TIMOTHY JOHN
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:KUNKLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3613
Mailing Address - Country:US
Mailing Address - Phone:724-388-2200
Mailing Address - Fax:
Practice Address - Street 1:1212 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1148
Practice Address - Country:US
Practice Address - Phone:814-886-2677
Practice Address - Fax:814-884-0175
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist