Provider Demographics
NPI:1407193865
Name:NIGHTINGALE, KRISTEN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8733
Mailing Address - Country:US
Mailing Address - Phone:803-407-2632
Mailing Address - Fax:803-407-3798
Practice Address - Street 1:2732 N LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8733
Practice Address - Country:US
Practice Address - Phone:803-407-2632
Practice Address - Fax:803-407-3798
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13656183500000X
OH03323933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist