Provider Demographics
NPI:1083054910
Name:CARLSON, KRISTI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CARLSON
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 1:147 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1408
Mailing Address - Country:US
Mailing Address - Phone:320-893-6102
Mailing Address - Fax:320-839-3985
Practice Address - Street 1:205 6TH AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MN
Practice Address - Zip Code:56256-1308
Practice Address - Country:US
Practice Address - Phone:320-598-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist