Provider Demographics
NPI:1326705153
Name:LARSON, KRISTY WILLIAMS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:WILLIAMS
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:WILLIAMS
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:705 LAKEGLEN DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3466
Mailing Address - Country:US
Mailing Address - Phone:912-669-8869
Mailing Address - Fax:
Practice Address - Street 1:6001 CUMMING HWY
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-6112
Practice Address - Country:US
Practice Address - Phone:678-546-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0212231835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist