Provider Demographics
NPI:1720498330
Name:KUNKEL, SUSAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KUNKEL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1266
Mailing Address - Country:US
Mailing Address - Phone:814-642-2284
Mailing Address - Fax:
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:OLEAN GENERAL HOSPITAL
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-375-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0502369-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist