Provider Demographics
NPI:1366672677
Name:SMITH, KRISTINE JEAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 SOMERVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8749
Mailing Address - Country:US
Mailing Address - Phone:716-465-1537
Mailing Address - Fax:
Practice Address - Street 1:3924 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4704
Practice Address - Country:US
Practice Address - Phone:716-835-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist