Provider Demographics
NPI:1396376422
Name:BENNETT, KRISTA COLLEEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:COLLEEN
Last Name:BENNETT
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 1:1435 W FROST DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2966
Mailing Address - Country:US
Mailing Address - Phone:801-725-2357
Mailing Address - Fax:
Practice Address - Street 1:1170 E GENTILE ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6802
Practice Address - Country:US
Practice Address - Phone:801-546-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT74771521701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist