Provider Demographics
NPI:1114439403
Name:WILSON, KRISTI KRAWIETZ (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KRAWIETZ
Last Name:WILSON
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 1:1386 PEACHTREE CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2335 BENT CREEK RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6434
Practice Address - Country:US
Practice Address - Phone:334-821-7112
Practice Address - Fax:334-821-7122
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist