Provider Demographics
NPI:1265662027
Name:MAHAN, KRISTIN CAMPBELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CAMPBELL
Last Name:MAHAN
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 1:1031 BELLEVUE AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1818
Mailing Address - Country:US
Mailing Address - Phone:314-560-5315
Mailing Address - Fax:
Practice Address - Street 1:1031 BELLEVUE AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1857
Practice Address - Country:US
Practice Address - Phone:314-646-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-144051835P0018X
MO20090168771835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist