Provider Demographics
NPI:1063720449
Name:KURDILLA, RENEE LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LYNN
Last Name:KURDILLA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-2063
Mailing Address - Country:US
Mailing Address - Phone:724-929-8896
Mailing Address - Fax:
Practice Address - Street 1:6039 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1107
Practice Address - Country:US
Practice Address - Phone:724-785-4522
Practice Address - Fax:724-785-2863
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP440957OtherPHARMACIST STATE LICENSE