Provider Demographics
NPI:1083899728
Name:WHITFORD, KRISTIN MYERS (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MYERS
Last Name:WHITFORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 MAELOU DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3736
Mailing Address - Country:US
Mailing Address - Phone:716-649-8959
Mailing Address - Fax:
Practice Address - Street 1:206 LAKE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4471
Practice Address - Country:US
Practice Address - Phone:716-646-3147
Practice Address - Fax:716-515-3309
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist