Provider Demographics
NPI:1346718558
Name:VAN MOLLE, KRISTIN ELISE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ELISE
Last Name:VAN MOLLE
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 1:43 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3401
Mailing Address - Country:US
Mailing Address - Phone:978-660-9940
Mailing Address - Fax:
Practice Address - Street 1:354 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3936
Practice Address - Country:US
Practice Address - Phone:603-352-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-04532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist