Provider Demographics
NPI:1225377252
Name:GOSSETT, KRISTINA LYNN (PHARM, D)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNN
Last Name:GOSSETT
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 1:1701 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1772
Mailing Address - Country:US
Mailing Address - Phone:734-755-6682
Mailing Address - Fax:
Practice Address - Street 1:47330 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2582
Practice Address - Country:US
Practice Address - Phone:734-414-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist