Basic Information
| Provider Information | |||||||||
| NPI: | 1417099888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIERNO | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 WEDGEMONT DR | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219214955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102781939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2501 OAKINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN PROVING GROUND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210055131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102781939 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 09302 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.