Provider Demographics
NPI:1326642893
Name:SMITH, KRISTIN LERESA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LERESA
Last Name:SMITH
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 1:19215 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CITRONELLE
Mailing Address - State:AL
Mailing Address - Zip Code:36522-4017
Mailing Address - Country:US
Mailing Address - Phone:251-866-9605
Mailing Address - Fax:251-866-9416
Practice Address - Street 1:19215 N 3RD ST
Practice Address - Street 2:
Practice Address - City:CITRONELLE
Practice Address - State:AL
Practice Address - Zip Code:36522-4017
Practice Address - Country:US
Practice Address - Phone:251-866-9605
Practice Address - Fax:251-866-9416
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist