Provider Demographics
NPI:1285232652
Name:RAINES, KRISTIE LYNN (RPH)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:LYNN
Last Name:RAINES
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 1:705 COOPER LN SW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2604
Mailing Address - Country:US
Mailing Address - Phone:256-566-5033
Mailing Address - Fax:
Practice Address - Street 1:241 HIGHWAY 31 SW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2855
Practice Address - Country:US
Practice Address - Phone:255-752-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL11932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist