Provider Demographics
NPI:1346848546
Name:DEMALINE, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DEMALINE
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 1:1001 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3113
Mailing Address - Country:US
Mailing Address - Phone:208-667-3860
Mailing Address - Fax:
Practice Address - Street 1:1001 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3113
Practice Address - Country:US
Practice Address - Phone:208-667-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412519183500000X
IDP9340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist