Provider Demographics
NPI:1164691952
Name:BERNTSON, KRISTEN KIEMELE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KIEMELE
Last Name:BERNTSON
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 1:789 PAUL LN
Mailing Address - Street 2:
Mailing Address - City:PLENTYWOOD
Mailing Address - State:MT
Mailing Address - Zip Code:59254-2155
Mailing Address - Country:US
Mailing Address - Phone:406-765-1273
Mailing Address - Fax:
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLENTYWOOD
Practice Address - State:MT
Practice Address - Zip Code:59254-1817
Practice Address - Country:US
Practice Address - Phone:406-765-1810
Practice Address - Fax:406-765-1811
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist