Provider Demographics
NPI:1407496987
Name:DICKSON, KRISTINA MARIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIA
Last Name:DICKSON
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 1:841 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6465
Mailing Address - Country:US
Mailing Address - Phone:859-619-0980
Mailing Address - Fax:
Practice Address - Street 1:170 BELLERIVE BLVD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8120
Practice Address - Country:US
Practice Address - Phone:859-219-2148
Practice Address - Fax:859-219-3497
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0123651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist