Provider Demographics
NPI:1346615499
Name:PEDERSEN, KRISTA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:PEDERSEN
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 1:724 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3255
Mailing Address - Country:US
Mailing Address - Phone:205-541-0807
Mailing Address - Fax:
Practice Address - Street 1:1011 PERRY HILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-4521
Practice Address - Country:US
Practice Address - Phone:334-270-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist