Provider Demographics
NPI:1326648072
Name:DELONG, KRISTY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:DELONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:DELONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:705 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6170
Mailing Address - Country:US
Mailing Address - Phone:417-527-8037
Mailing Address - Fax:
Practice Address - Street 1:2004 W MARLER LN
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7661
Practice Address - Country:US
Practice Address - Phone:417-581-3238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006021579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist