Provider Demographics
NPI:1104193374
Name:VENABLES, KRISTEN M (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:VENABLES
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 1:161 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2464
Mailing Address - Country:US
Mailing Address - Phone:860-522-5005
Mailing Address - Fax:860-522-5405
Practice Address - Street 1:161 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2464
Practice Address - Country:US
Practice Address - Phone:860-522-5005
Practice Address - Fax:860-522-5405
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist