Provider Demographics
NPI:1043208887
Name:WILLETT, KRISTINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:WILLETT
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 1:236 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3154
Mailing Address - Country:US
Mailing Address - Phone:603-314-1778
Mailing Address - Fax:
Practice Address - Street 1:1260 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1305
Practice Address - Country:US
Practice Address - Phone:603-314-1778
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist