Provider Demographics
NPI:1407450869
Name:MARKUSON, KRISTI (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MARKUSON
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 1:31190 N JENSEN LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1134
Mailing Address - Country:US
Mailing Address - Phone:847-848-7408
Mailing Address - Fax:
Practice Address - Street 1:250 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5943
Practice Address - Country:US
Practice Address - Phone:847-960-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist