Provider Demographics
NPI:1861742371
Name:MAURO, KATHLEEN (RPH)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MAURO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROUNDTREE CIR
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-4212
Mailing Address - Country:US
Mailing Address - Phone:646-361-3477
Mailing Address - Fax:
Practice Address - Street 1:25 ROUNDTREE CIR
Practice Address - Street 2:
Practice Address - City:PIERMONT
Practice Address - State:NY
Practice Address - Zip Code:10968-4212
Practice Address - Country:US
Practice Address - Phone:646-361-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0377991835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist