Provider Demographics
NPI:1033410105
Name:ELIASON, KRISTINA R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:R
Last Name:ELIASON
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 1:5891 S WENAS RD
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-9198
Mailing Address - Country:US
Mailing Address - Phone:509-654-0152
Mailing Address - Fax:
Practice Address - Street 1:905 E MEAD AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-3721
Practice Address - Country:US
Practice Address - Phone:509-248-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60087289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist