Provider Demographics
NPI:1275829392
Name:WILLIAMS, KRISTINA SUZANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:SUZANNE
Last Name:WILLIAMS
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 1:15300 GROVE CIR N
Mailing Address - Street 2:T-2193
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4469
Mailing Address - Country:US
Mailing Address - Phone:763-447-2507
Mailing Address - Fax:763-447-2517
Practice Address - Street 1:11330 FOUNTAINS DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7200
Practice Address - Country:US
Practice Address - Phone:763-494-8059
Practice Address - Fax:763-494-8056
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist