Provider Demographics
NPI:1225311152
Name:ROTHER, KRISTYN ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTYN
Middle Name:ELIZABETH
Last Name:ROTHER
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 1:326 DE MUN AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2208
Mailing Address - Country:US
Mailing Address - Phone:314-803-8858
Mailing Address - Fax:
Practice Address - Street 1:2401 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2208
Practice Address - Country:US
Practice Address - Phone:314-963-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist