Provider Demographics
NPI:1376828806
Name:SANFORD, KRISTINA JEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:JEAN
Last Name:SANFORD
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 1:2510 WYNNTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2184
Mailing Address - Country:US
Mailing Address - Phone:706-327-6181
Mailing Address - Fax:
Practice Address - Street 1:2510 WYNNTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2184
Practice Address - Country:US
Practice Address - Phone:706-327-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist