Provider Demographics
NPI:1093144016
Name:DISTLER, CHRISTY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:LYNN
Last Name:DISTLER
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 1:9000 METCALF AVE
Mailing Address - Street 2:WAL-MART NEIGHBORHOOD MARKET #5207
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1457
Mailing Address - Country:US
Mailing Address - Phone:913-649-4314
Mailing Address - Fax:913-649-4483
Practice Address - Street 1:9000 METCALF AVE
Practice Address - Street 2:WAL-MART NEIGHBORHOOD MARKET #5207
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1457
Practice Address - Country:US
Practice Address - Phone:913-649-4314
Practice Address - Fax:913-649-4483
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13438183500000X
MO2004020355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist