Provider Demographics
NPI:1437541729
Name:WOLTER, KRISTIN JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOY
Last Name:WOLTER
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 1:2320 W PEORIA AVE STE D132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4768
Mailing Address - Country:US
Mailing Address - Phone:877-678-5400
Mailing Address - Fax:602-678-5401
Practice Address - Street 1:2320 W PEORIA AVE STE D132
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4768
Practice Address - Country:US
Practice Address - Phone:877-678-5400
Practice Address - Fax:602-678-5401
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018586183500000X
AL18314183500000X
ARPD12603183500000X
IDP7016183500000X
KY170030183500000X
LAPST.020517183500000X
MD22348183500000X
MSP13378183500000X
NE14523183500000X
NJ28RI0369000183500000X
ORRPH-0014092183500000X
TN38099183500000X
VA0202-212893183500000X
WVRP0008504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist