Provider Demographics
NPI:1063871051
Name:MONTEROLA, KATHLEEN ANN
Entity type:Individual
Prefix:
First Name:KATHLEEN ANN
Middle Name:
Last Name:MONTEROLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RED SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7053
Mailing Address - Country:US
Mailing Address - Phone:800-221-6564
Mailing Address - Fax:877-900-5566
Practice Address - Street 1:80 RED SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7053
Practice Address - Country:US
Practice Address - Phone:800-221-6564
Practice Address - Fax:877-900-5566
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist