Provider Demographics
NPI:1265664841
Name:HOLBY, KRISTEN (RPH, PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:HOLBY
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1954
Mailing Address - Country:US
Mailing Address - Phone:718-353-1571
Mailing Address - Fax:718-353-3172
Practice Address - Street 1:3526 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1954
Practice Address - Country:US
Practice Address - Phone:718-353-1571
Practice Address - Fax:718-353-3172
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052692OtherNY STATE LICENSE NUMBER