Provider Demographics
NPI:1073807327
Name:LOCKHART, KRISTIE MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:MARIE
Last Name:LOCKHART
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 1:3301 HIGHWAY 10 E
Mailing Address - Street 2:T-0658
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2516
Mailing Address - Country:US
Mailing Address - Phone:218-233-2953
Mailing Address - Fax:218-233-2953
Practice Address - Street 1:3301 HIGHWAY 10 E
Practice Address - Street 2:T-0658
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2516
Practice Address - Country:US
Practice Address - Phone:218-233-2953
Practice Address - Fax:218-233-2953
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist