Provider Demographics
NPI:1740872837
Name:GWIN, KELLY RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:GWIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3150
Mailing Address - Country:US
Mailing Address - Phone:724-944-6778
Mailing Address - Fax:
Practice Address - Street 1:7500 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108-2532
Practice Address - Country:US
Practice Address - Phone:412-893-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist