Provider Demographics
NPI:1306181110
Name:RADOSEVICH, KRISTI LOUISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:LOUISE
Last Name:RADOSEVICH
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 1:905 BRIDGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-5879
Mailing Address - Country:US
Mailing Address - Phone:307-875-7841
Mailing Address - Fax:
Practice Address - Street 1:905 BRIDGER DR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-5879
Practice Address - Country:US
Practice Address - Phone:307-875-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist