Provider Demographics
NPI:1376195776
Name:CARLING, KRYSTON CHENAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRYSTON
Middle Name:CHENAY
Last Name:CARLING
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 1:1430 PARAMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3053
Mailing Address - Country:US
Mailing Address - Phone:208-242-7498
Mailing Address - Fax:
Practice Address - Street 1:1295 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1683
Practice Address - Country:US
Practice Address - Phone:208-785-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist