Provider Demographics
NPI:1174850879
Name:NOSTROM, KRISTIN ANN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANN
Last Name:NOSTROM
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 1:2216 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-2447
Mailing Address - Country:US
Mailing Address - Phone:712-852-2886
Mailing Address - Fax:712-852-2534
Practice Address - Street 1:2216 MAIN ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2447
Practice Address - Country:US
Practice Address - Phone:712-852-2886
Practice Address - Fax:712-852-2534
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist