Provider Demographics
NPI:1407302185
Name:KRIEGER, KARLA JEAN (RPH)
Entity Type:Individual
Prefix:MISS
First Name:KARLA
Middle Name:JEAN
Last Name:KRIEGER
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 1:240 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5401
Mailing Address - Country:US
Mailing Address - Phone:208-354-0057
Mailing Address - Fax:208-354-9916
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5401
Practice Address - Country:US
Practice Address - Phone:208-354-0057
Practice Address - Fax:208-354-9916
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist