Provider Demographics
NPI:1144746090
Name:COLE, KRISTIN M (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CROSSWAYS PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2055
Mailing Address - Country:US
Mailing Address - Phone:516-249-7436
Mailing Address - Fax:516-249-7437
Practice Address - Street 1:415 CROSSWAYS PARK DR STE B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2055
Practice Address - Country:US
Practice Address - Phone:516-249-7436
Practice Address - Fax:516-249-7437
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist