Provider Demographics
NPI:1275802704
Name:JANSEN, KRISTEN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JANSEN
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 1:14709 LAUREL LAKE LN
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3208
Mailing Address - Country:US
Mailing Address - Phone:813-785-3323
Mailing Address - Fax:
Practice Address - Street 1:2916 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9408
Practice Address - Country:US
Practice Address - Phone:813-402-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist