Provider Demographics
NPI:1235290065
Name:ADAMS, KRISTEN CLARISSA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CLARISSA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1239
Mailing Address - Country:US
Mailing Address - Phone:509-758-2380
Mailing Address - Fax:
Practice Address - Street 1:1275 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2846
Practice Address - Country:US
Practice Address - Phone:509-758-5533
Practice Address - Fax:509-751-9545
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015904183500000X
IDP4857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4902981OtherNABP
WA6173801Medicaid