Provider Demographics
NPI:1326398223
Name:PHELPS, KRISTI EVANS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:EVANS
Last Name:PHELPS
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 1:1533 AMBERJACK DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-7133
Mailing Address - Country:US
Mailing Address - Phone:228-990-2400
Mailing Address - Fax:
Practice Address - Street 1:4300 NEW GETWELL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6801
Practice Address - Country:US
Practice Address - Phone:901-238-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08845183500000X
LAPST019682183500000X
AL16910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist