Provider Demographics
NPI:1124361340
Name:STUART, KRISTYN M
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:M
Last Name:STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6425
Mailing Address - Country:US
Mailing Address - Phone:303-682-4170
Mailing Address - Fax:303-682-4171
Practice Address - Street 1:6110 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6425
Practice Address - Country:US
Practice Address - Phone:303-682-4170
Practice Address - Fax:303-682-4171
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13947183500000X
CO19292183500000X
CO00192921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist