Provider Demographics
NPI:1326325234
Name:POORE, KRISTEN E (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:POORE
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 1:5014 MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1077
Mailing Address - Country:US
Mailing Address - Phone:515-210-1507
Mailing Address - Fax:
Practice Address - Street 1:6200 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1225
Practice Address - Country:US
Practice Address - Phone:515-331-0497
Practice Address - Fax:515-331-2306
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist