Provider Demographics
NPI:1114057122
Name:MENNEN, KRISTINE (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:MENNEN
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 1:29 GOLDFINCH CIR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-4120
Mailing Address - Country:US
Mailing Address - Phone:319-338-2571
Mailing Address - Fax:
Practice Address - Street 1:525 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1206
Practice Address - Country:US
Practice Address - Phone:319-363-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist