Provider Demographics
NPI:1124573852
Name:QUIZON, KRISTINE ANNE MARIE KALUGDAN
Entity Type:Individual
Prefix:MISS
First Name:KRISTINE ANNE MARIE
Middle Name:KALUGDAN
Last Name:QUIZON
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 1:1926 NE 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1648
Mailing Address - Country:US
Mailing Address - Phone:954-278-5973
Mailing Address - Fax:
Practice Address - Street 1:1926 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1648
Practice Address - Country:US
Practice Address - Phone:954-278-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist