Provider Demographics
NPI:1184224867
Name:MCKEON, KRISTINA MAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MAE
Last Name:MCKEON
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 1:31 PILGRIM DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6038
Mailing Address - Country:US
Mailing Address - Phone:207-233-7838
Mailing Address - Fax:
Practice Address - Street 1:725 GOLD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4008
Practice Address - Country:US
Practice Address - Phone:603-621-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist